Obesity: A Ticking Time Bomb for Reproductive Health (Elsevier Insights)

DebateGraph: A new way to address the complexity of obesity

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Obesity : a ticking time bomb for reproductive health

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The E-mail message field is required. Please enter the message. Please verify that you are not a robot. Would you also like to submit a review for this item? You already recently rated this item. Your rating has been recorded. Write a review Rate this item: Preview this item Preview this item. Tahir Mahmood ; Sabaratnam Arulkumaran Publisher: Obesity is a continuing issue around the world and in many contexts.

The growing number of obese people is an increasing concern for those in the medical profession, and obesity can pose specific challenges in relation to fertility and pregnancy. Patients who are obese require specific considerations and knowledge. Bringing together experts from a variety of specialties to examine the issues and challenges of obesity, this book discusses how obesity affects fertility, reproduction, and pregnancy. Beginning with an exploration of the epidemiology of obesity, further chapters focus on specific issues related to obesity and both male and female reproduction, the complications of obesity during pregnancy and labour, and the long term effects of obesity.

Medical management of heavy menstrual bleeding

This is the most comprehensive resource to examine the topic of obesity and reproductive issues, making it invaluable for medical students, professionals, and researchers in public policy and medicine. Comprehensive examination of fertility issues arising from male and female obesity. Clinical knowledge and expertise given to the subjects.

In-depth examination through 47 chapters of a growing, but often overlooked, issue in fertility and pregnancy. Allow this favorite library to be seen by others Keep this favorite library private. Find a copy in the library Finding libraries that hold this item Tahir Mahmood ; Sabaratnam Arulkumaran Find more information about: Tahir Mahmood Sabaratnam Arulkumaran.

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Nonhormonal treatments for HMB

Clinical Care of the Child with Obesity: A scientific method of treating and combating youth weight problems scientific Care of the kid With weight problems is written to teach physicians to appreciate the pathophysiology and etiologies of weight problems, to spot and deal with pediatric sufferers with weight problems and to benefit abilities to be used of their destiny practices and groups. Read e-book online Die digitale Abformung bis zum fertigen Zahnersatz: Die Entwicklung neuer digitaler Techniken hat in den vergangenen Jahren die Zahntechnik geradezu revolutioniert.

Additional resources for Recognizing and Correcting Developing Malocclusions: As there is no stimulation of the endometrium from the resulting low ovarian hormone levels, menstruation does not take place.

GnRH agonists are particularly useful in the treatment of uterine fibroids leiomyoma , which can reduce considerably in size when ovarian hormone levels are suppressed. However, these compounds are associated with very significant side effects secondary to estrogen deficiency that limit use; namely flushing, vaginal dryness, headaches and decreased libido.

This is necessary after 6 months of use to protect bone mineral density.

Usually the GnRH agonist is commenced alone, to achieve maximal effects on menstrual blood loss and fibroid shrinkage and discontinued after 6 months. An exciting new group of pharmacological agents is in development and has the future potential to provide effective oral treatment for HMB. These selective progesterone receptor modulators SPRMs impart a tissue-specific partial progesterone antagonist effect and act upon progesterone receptors in the endometrium and the underlying myometrial tissue. They have the additional benefit of maintenance of estradiol levels, meaning hypoestrogenic side effects are not an issue.

The mechanism by which these SPRMs reduce menstrual blood loss is still to be fully defined but distinct histological morphology has been identified with their use progesterone receptor modulator associated endometrial changes [PAEC]. Ulipristal Acetate UPA is the only SPRM to have been licensed for use in clinical practice, albeit restricted to 3 months pretreatment of fibroids prior to surgical removal.

Study of the endometrium of women taking this treatment regimen showed altered architectural features including extensive cystic dilatation of the epithelial glands, inactivity or features of abortive subnuclear vacuolization, occasional mitoses and apoptosis. There are no publications to date on the clinical utility of SPRMs in the management of women with HMB who do not have fibroids or who have other conditions associated with HMB, such as adenomyosis. These studies have concluded that short term use of UPA is effective in treating HMB associated with uterine fibroids 3—10 cm in size.

However, UPA also has the potential to provide a safe, fertility preserving, rapidly effective and convenient oral medical treatment for women with HMB whether associated with fibroids or not.

Clinical trials are currently in progress to assess SPRMs in this group of women. This further research is required to fully understand their mechanism of action, longer-term safety and effectiveness prior to recommending their use as a long-term medical treatment option for women with HMB with and without fibroids. A number of medical options and routes of administration exist for the hundreds of thousands of women in the UK who suffer from HMB. Unfortunately, most are associated with hormonal side effects and limited efficacy.

SPRMs offer hope of a new, fertility sparing class of medical therapies for these women that may provide a long-term treatment option. Continued research into the causes of HMB will yield new medical therapies for this common, debilitating disorder to improve the quality of life of many women. The authors thank S Milne for her help with manuscript preparation and R Grant for support with illustrations.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. To view a copy of this license, visit http: National Center for Biotechnology Information , U. Journal List Womens Health Lond v. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC.

Abstract Women with benign heavy menstrual bleeding have the choice of a number of medical treatment options to reduce their blood loss and improve quality of life. Abnormal uterine bleeding may be a result of aberrations in: Open in a separate window. NSAID preparations Studies examining women with objectively measured heavy and normal menstrual bleeding have repeatedly demonstrated that increased local inflammation is associated with increased menstrual blood loss. Synthesis and signalling of prostaglandins.

Hormonal treatments for HMB Human endometrial function is governed by the ovarian steroid hormones. Impact of levonorgestrel-releasing intrauterine system on bleeding and spotting in the first year of use. Women should be advised that they may experience daily spotting but that this usually settles after 6 months.

Perseverance for a minimum of 6 months is required for benefits to be appreciated and for unscheduled, usually light, bleeding to subside Figure 3.

Some clinicians recommend that women should not use tampons in this time to minimize this risk. If they notice an offensive discharge they must seek medical advice and may require antibiotic treatment. After 3 weeks post-insertion, their risk of infection returns to the same as women without an IUS;.

Val Bullen, David Price

Women should be advised to check the threads by digital self-examination on a regular basis, particularly if relying on the IUS for contraception. If they are not happy to do so, they should have a speculum examination 6 weeks after insertion to ensure the IUS is in place before relying on it for contraception;. Distortion of the endometrial cavity, uterine infection or being less than 4 weeks postpartum will increase the risk of perforation substantially. Suspicion of perforation at the time of insertion warrants ultrasonic assessment.

A woman should be advised to seek medical help if post insertion cramps are not eased with routine analgesics. Progesterone only pill In contrast to the combined pill, the progesterone only pill POP is associated with irregular and unpredictable blood loss. Injectable progestogens Intramuscular or subcutaneous injection of high dose progestogens e.

Oral progestogens Norethisterone is the most commonly used oral progestogen in the treatment of HMB. Gonadotropin-releasing hormone agonists These are synthetic peptides administered by an intramuscular, subcutaneous or intranasal route and utility should really be for short-term use. Novel treatments for HMB Selective progesterone receptor modulators An exciting new group of pharmacological agents is in development and has the future potential to provide effective oral treatment for HMB. Various medical treatment options are available but side effects often limit compliance and efficacy.

Hormonal options include the levonorgestrel-releasing intrauterine system, the combined oral contraceptive pill or progestogen preparations.

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