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The effect of heavy menstrual bleeding (HMB) on quality of life in women with a bleeding disorder is not fully recognised, despite being a prevalent issue ( Table 1 ). Prolonged bleeding interferes with daily life and causes marked blood loss, resulting in anaemia and fatigue. Girls and women have to take time off school or work to cope with the impact, marking them out as different from their peers, which in turn risks causing isolation. There is concern that the bleeding disorders community has a double standard when it comes to HMB. If a man with a bleeding

social life; this was greater among women with a platelet disorder, other factor deficiencies or unknown diagnosis. Between 40% and 70% of women in all groups reported that their bleeding disorder had a significant impact on their ability or willingness to have children, or prevented it. The impact of bleeding on daily life ranged from nose bleeds (higher in women with VWD or a combined factor deficiency) and bruising (highest in those with a platelet disorder), but heavy menstrual bleeding had the greatest impact of all. This was reported by 70% of women with VWD, 41

with irregular menstrual bleeding should not use Cyklokapron until the cause of irregular bleeding has been established. If menstrual bleeding is not adequately reduced by Cyklokapron, an alternative treatment should be considered. Clinical experience with Cyklokapron in menorrhagic children under 15 years of age is not available. Fibrinolytic conditions following consumption coagulopathy History of convulsions Tranexamic acid should be administered with care in patients receiving oral contraceptives because of the increased risk of thrombosis. Patients with a

: prevalence, impact and recent knowledge. PER13(2):512–20. Drosdzol-Cop A, Bąk-Sosnowska M, Sajdak D, Białka A, Kobiołka A, Franik G, et al. 2017.Assessment of the menstrual cycle, eating disorders and self-esteem of Polish adolescents. J Psychosom Obstet Gynaecol 38(1):30–36. Ellison PT, Lager C.1986. Moderate recreational running is associated with lowered salivary progesterone profiles in women. Am J Obstet Gynecol 154:1000–03. Elshiekh M, Ali Mohammed AM. 2011. Influence of socioeconomic status in the age at the of menarche and duration of menstrual bleeding. Mater

and platelet dysfunction due to medication) had two children at age 20; both deliveries were uncomplicated. In 2018, she underwent hysterectomy for heavy menstrual bleeding as she could not tolerate hormonal therapy. The outcome of surgery was complicated by infection, vaginal bleeding and bladder atonia, which she continues to manage with catheterisation. She experienced monthly midcycle abdominal pain for which she self-treated with VWF/factor VIII complex when self-testing confirmed ovulation had occurred. In 2019, she was admitted to hospital with ovulation


Menstrual health is one of the major areas of concern in reproductive health, and affects a large number of women throughout their reproductive life from adolescence. Menstruation is a biological phenomenon imbued with social-cultural, nutritional and personal significance. The present study aims to focus on the menstrual characteristics and its association with socio-demographic factors and nutritional status among the urban slum adolescent girls of North 24 Parganas district, West Bengal. This community-based study was conducted among a group of 90 Bengali speaking Hindu adolescent girls aged between 16 to 18 years. A pre-tested structured schedule was used to collect detailed information about the socio-economic conditions and menstrual characteristics. All anthropometric measurements were taken using the standard procedures. Results of the study revealed that underweight girls attained menarche comparatively in later age (12.67±1.23) than that of healthy and overweight girls. Mean length of the menstrual cycle, mean duration of menstrual bleeding and mean number of days of peak discharge were maximum among the girls whose BMI was below 5th percentile, i.e. underweight. Majority of the underweight (75%) and healthy (50%) girls experienced heavy discharge during their menstrual days. Disorders like premenstrual syndrome (PMS) (78.8%) and dysmenorrhea (85.5%) were the major prevalent menstrual problems among these girls and occurrence of the symptoms of these disorders significantly varied based on their BMI. A highly significant difference (p<0.01) was found among underweight, healthy and overweight girls in terms of duration of menstrual bleeding, mean number of days of peak discharge and occurrences of PMS. Result of linear regression and step wise logistic regression (backward elimination) shows that various socio-economic and anthropometric variables are the influential predictors of menstrual characteristics like duration of menstrual discharge, cycle length, days of peak discharge as well as menstrual problems like cycle irregularity and heavy flow (p<0.05). Therefore, the present study unwraps a podium to focus on the menstrual health issues of the adolescent girls and enforce health education as well as instigates nutritional intervention programme to fortify the existing menstrual health status.

References 1. Goldstein SR, Lumsden MA. Abnormal uterine bleeding in perimenopause. Climacteric. 2017 Oct;20(5):414-420 DOI: 10.1080/13697137.2017.1358921 2. Cooke AG, McCavit TL, Buchanan GR, Powers JM, Iron Deficiency Anemia in Adolescents Presenting with Heavy Menstrual Bleeding, J Pediatr Adolesc Gynecol, 2017 Apr;30(2):247-250 DOI: 10.1016/j.jpag.2016.10.010 3. Padmakumar R, Pai M, Farish S, Rajeev J, Sanjeev T, Sreevalsan TV et al. Successful bowel surgery at hemoglobin 2 g/dL without blood transfusion. World J Gastrointest Surg 2013 Aug;5(8):252-255 DOI

fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions - an overview. J Forensic Sci 2012; 57:665-668. 15. SRETTABUNJONG S. Systemic thromboembolism after deep vein thrombosis caused by uterine myomas. Am J Forensic Med Pathol 2013; 34:207-209. 16. BARSAM S, BAGOT C, PATEL R, SIDHU PS, DAVIES A, ARYA R. Extrinsic venous compression: a sufficient explanation for venous thromboembolism due to massive fibroids? Thromb Haemost 2006; 96:694-696. 17. NELSON AL, RITCHIE JJ. Severe anemia from heavy menstrual bleeding requires heightened attention. Am

uterine receptivity. Fertil Steril. 2011;95(8):2690-2692. 12. Mouhayar Y, Yin O, Mumford SL, Segars JH. Hysteroscopic polypectomy prior to infertility treatment: A cost analysis and systematic review. Eur J Obstet Gynecol Reprod Biol. 2017;213:107-115. 13. JustinW, Ibraheim M, Bagtharia S, et al. Current minimal access techniques in the treatment of heavy menstrual bleeding. Obstet Gynaecol. 2007;9:224-232. 14. Cooper NAM, Robinson LLL, Clark TJ Ambulatory hysteroscopy and its role in the management of abnormal uterine bleeding Journal of Family Planning and

her menstrual cycle, just prior to the start of her teenage years. Her first menstrual cycle resulted in her admission to the intensive care unit (ICU), where emergency measures were required to save her life. Recently (since last summer), she has experienced increased menstrual bleeding; she was admitted recently for a blood transfusion along with IV oestrogen due to uncontrolled dysfunctional uterine bleeding causing symptomatic anaemia. The bleeding improved prior to discharge; however, once discharged the bleeding returned along with the passing of abnormally