Heavy menstrual bleeding: assessment and management
This guideline covers assessing and managing heavy menstrual bleeding (menorrhagia). It aims to help healthcare professionals investigate the cause of heavy periods that are affecting a woman’s quality of life and to offer the right treatments, taking into account the woman’s priorities and preferences.
Published March: 2018
Next Review:2020
Full guidance found at https://www.nice.org.uk/guidance/ng88
Showing posts with label menstruation. Show all posts
Showing posts with label menstruation. Show all posts
Wednesday, 21 March 2018
Friday, 22 December 2017
Analysis of chromatin accessibility in decidualizing human endometrial stromal cells
FASEB J. 2017 Dec 19. pii: fj.201701098R. doi: 10.1096/fj.201701098R. [Epub ahead of print]
Spontaneous decidualization of the endometrium in response to progesterone signaling is confined to menstruating species, including humans and other higher primates. During this process, endometrial stromal cells (EnSCs) differentiate into specialized decidual cells that control embryo implantation. We subjected undifferentiated and decidualizing human EnSCs to an assay for transposase accessible chromatin with sequencing (ATAC-seq) to map the underlying chromatin changes. A total of 185,084 open DNA loci were mapped accurately in EnSCs. Altered chromatin accessibility upon decidualization was strongly associated with differential gene expression. Analysis of 1533 opening and closing chromatin regions revealed over-representation of DNA binding motifs for known decidual transcription factors (TFs) and identified putative new regulators. ATAC-seq footprint analysis provided evidence of TF binding at specific motifs. One of the largest footprints involved the most enriched motif-basic leucine zipper-as part of a triple motif that also comprised the estrogen receptor and Pax domain binding sites. Without exception, triple motifs were located within Alu elements, which suggests a role for this primate-specific transposable element (TE) in the evolution of decidual genes. Although other TEs were generally under-represented in open chromatin of undifferentiated EnSCs, several classes contributed to the regulatory DNA landscape that underpins decidual gene expression.
UHCW Research: Vrljicak P, Lucas, E S, and Brosens, J J
Spontaneous decidualization of the endometrium in response to progesterone signaling is confined to menstruating species, including humans and other higher primates. During this process, endometrial stromal cells (EnSCs) differentiate into specialized decidual cells that control embryo implantation. We subjected undifferentiated and decidualizing human EnSCs to an assay for transposase accessible chromatin with sequencing (ATAC-seq) to map the underlying chromatin changes. A total of 185,084 open DNA loci were mapped accurately in EnSCs. Altered chromatin accessibility upon decidualization was strongly associated with differential gene expression. Analysis of 1533 opening and closing chromatin regions revealed over-representation of DNA binding motifs for known decidual transcription factors (TFs) and identified putative new regulators. ATAC-seq footprint analysis provided evidence of TF binding at specific motifs. One of the largest footprints involved the most enriched motif-basic leucine zipper-as part of a triple motif that also comprised the estrogen receptor and Pax domain binding sites. Without exception, triple motifs were located within Alu elements, which suggests a role for this primate-specific transposable element (TE) in the evolution of decidual genes. Although other TEs were generally under-represented in open chromatin of undifferentiated EnSCs, several classes contributed to the regulatory DNA landscape that underpins decidual gene expression.
UHCW Research: Vrljicak P, Lucas, E S, and Brosens, J J
Wednesday, 13 December 2017
Clearance of senescent decidual cells by uterine natural killer cells in cycling human endometrium
Elife. 2017 Dec 11;6. pii: e31274. doi: 10.7554/eLife.31274.
In cycling human endometrium, menstruation is followed by rapid estrogen-dependent growth. Upon ovulation, progesterone and rising cellular cAMP levels activate the transcription factor Forkhead box O1 (FOXO1) in endometrial stromal cells (EnSCs), leading to cell cycle exit and differentiation into decidual cells that control embryo implantation. Here we show that FOXO1 also causes acute senescence of a subpopulation of decidualizing EnSCs in an IL-8 dependent manner. Selective depletion or enrichment of this subpopulation revealed that decidual senescence drives the transient inflammatory response associated with endometrial receptivity. Further, senescent cells prevent differentiation of endometrial mesenchymal stem cells in decidualizing cultures. As the cycle progresses, IL-15 activated uterine natural killer (uNK) cells selectively target and clear senescent decidual cells through granule exocytosis. Our findings reveal that acute decidual senescence governs endometrial rejuvenation and remodeling at embryo implantation, and suggest a critical role for uNK cells in maintaining homeostasis in cycling endometrium.
UHCW Research: Vrljicak P, Tewary S, Lucas, E S and Ott S
In cycling human endometrium, menstruation is followed by rapid estrogen-dependent growth. Upon ovulation, progesterone and rising cellular cAMP levels activate the transcription factor Forkhead box O1 (FOXO1) in endometrial stromal cells (EnSCs), leading to cell cycle exit and differentiation into decidual cells that control embryo implantation. Here we show that FOXO1 also causes acute senescence of a subpopulation of decidualizing EnSCs in an IL-8 dependent manner. Selective depletion or enrichment of this subpopulation revealed that decidual senescence drives the transient inflammatory response associated with endometrial receptivity. Further, senescent cells prevent differentiation of endometrial mesenchymal stem cells in decidualizing cultures. As the cycle progresses, IL-15 activated uterine natural killer (uNK) cells selectively target and clear senescent decidual cells through granule exocytosis. Our findings reveal that acute decidual senescence governs endometrial rejuvenation and remodeling at embryo implantation, and suggest a critical role for uNK cells in maintaining homeostasis in cycling endometrium.
UHCW Research: Vrljicak P, Tewary S, Lucas, E S and Ott S
Wednesday, 4 January 2017
PMDD: Severe form of PMS affecting women's mental health 'linked to cell disorder'
A severe form of premenstrual syndrome (PMS) which negatively affects a woman’s mood may be caused by a cellular disorder, according to a new study.
Women with the little understood but debilitating condition known as premenstrual dysphoric disorder (PMDD) are more likely to experience feelings of anxiety, sadness, and irritability in the days before their periods. Psychological symptoms include changes in appetite, cramps, bloating, headaches, hot flashes, breast tenderness, and joint and muscle pain.
Women with the little understood but debilitating condition known as premenstrual dysphoric disorder (PMDD) are more likely to experience feelings of anxiety, sadness, and irritability in the days before their periods. Psychological symptoms include changes in appetite, cramps, bloating, headaches, hot flashes, breast tenderness, and joint and muscle pain.
Wednesday, 30 November 2016
Updated advice on the diagnosis and treatment of women with premenstrual syndrome (PMS)
The timing of symptoms and degree of impact on daily activity determines a diagnosis of premenstrual syndrome (PMS), state revised guidelines for healthcare professionals published by the Royal College of Obstetricians and Gynaecologists (RCOG).
Monday, 19 September 2016
Outpatient endometrial ablation
Answer to the question, 'What is the evidence regarding the safety, and patient satisfaction of outpatient endometrial ablation (EA) techniques?' added to the RCOG Query Bank.
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