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First menstrual period: the menstrual cycle often begins at puberty between the ages of 8 and 15 (average age of 12) cholesterol test smoking quality tricor 160mg. Phases of the menstrual cycle: There are four phases: menstruation cholesterol test price buy cheap tricor 160 mg online, the follicular phase cholesterol medication and memory loss purchase 160 mg tricor otc, ovulation and the luteal phase cholesterol levels beer cheap tricor 160 mg with visa. It usually lasts three to seven days but this could change to more or less days from month to month and depending on each woman. During this phase the pituitary gland (situated at the base of the brain) releases a follicle (cyst) stimulating hormone. This hormone produces 10 to 20 follicles in the ovary and each follicle houses an immature egg. These follicles produce the hormone estrogen, which in turn thickens the lining of the endometrium in preparation to receive a fertilized egg. Often, only one follicle keeps growing and travels to the ovarian surface while the remaining follicles gradually fade and are absorbed back into the body. The term “ovulation” indicates the formation of a mature egg by one of the ovaries. The release of estrogen during the follicular phase causes the brain to produce a gonadotrophin-releasing hormone that prompts the pituitary gland to produce raised levels of luteinising hormone (luteotropic hormone). This extracts the mature egg from the follicle (cyst) and transports it from the ovary to the fallopian tube. If fertilization does not occur during this phase, the egg continues to the uterus and dissolves within 6 to 24 hours. The two hormones help thicken the lining of the endometrium and maintain its thickness. If fertilization does not occur, the yellow body degrades and progesterone levels decrease, leaving the lining unstable. These include: Physical changes: o Breast tenderness and swelling o Diarrhea or constipation o Bloating and gas o Cramps o Headaches or backaches o Fluid retention o Fatigue and vertigo o Inability to tolerate noise or bright lights o Acne Psychological changes: o Aggressive behavior and irritability o Trouble sleeping (too much or too little) o Changes in appetite o Difficulty concentrating and remembering o Stress and anxiety o Mood swings o Depression or sadness o Reduced libido these changes occur due to the sudden drop in progesterone and estrogen. However, they disappear a few days after menstruation once hormones are back to their elevated levels. Common issues accompanying the menstrual cycle: § Cramps: Many women experience stomach spasms during the first few days of their cycle. They occur because of chemicals in the body that cause the uterine muscles to contract to help shed the uterine lining. There are two types of dysmenorrhea: Primary dysmenorrhea: It is a very common condition that occurs because of the contraction in uterine muscles. You are more likely to suffer from primary dysmenorrhea if you: o Started menstruating before the age of 11 o Have heavy and long periods o Smoke o Experience psychological pressures Secondary dysmenorrhea: It is the pain resulting from physical problems. The pain becomes worse with age and lasts longer than the pain of primary dysmenorrhea. The most common health issues that may cause it are: o Endometriosis o Uterine fibroids o Ovarian cysts § Irregular periods: A girl’s body begins to regulate her menstrual period 2-3 years after the cycle starts. During this time, the body tries to adjust to the hormonal changes it is experiencing. Irregularities general occur for the following reasons: o Eating disorders o Thyroid disorders o Some medicines. When to see a doctor: See a doctor if any of the following problems occurs during puberty: If the menstrual cycle begins before the age of 8 If a girl is 15 years old but hasn’t started her cycle If the cycle doesn’t start within three years of breast development If the menstrual cycle remains irregular after the first three years See a doctor if the following problems occur during menstruation: o If the symptoms are severe to the point of hindering daily activities o If painkillers don’t help relieve menstrual pains o If large and abnormal clots are discharged with the blood o If cramps are felt outside the usual times (before and during menstruation) o If menstruation continues for over 8 days o If you need to change sanitary napkins every one or two hours o If you experience symptoms of iron deficiency anemia (including: dizziness, weakness, fatigue, chest pain, difficulty breathing) o If you experience changes in menstruation (unusually heavy periods) See a doctor if the following problems occur outside menstruation: o Bleeding after intercourse (more than once) o Bleeding outside menstrual period o Bleeding after menopause Diagnosis: • Family history: the pattern of a girl’s menstrual cycle follows that of her mother’s. If pain is due to endometriosis, it is usually chronic and is not easily alleviated by painkillers. If the endometriosis is advanced, it may block the fallopian tubes and cause infertility. Some herbs may alleviate menstrual cramps and pain but have no link to cleaning the uterus. Overusing these washes may undermine the vagina’s immunity and put it at risk of yeast infections. Yes, if it is linked to period days and doesn’t occur days after bleeding has stopped. Truth: Brown discharge at the start of the menstrual cycle comes from the surface of the endometrium before the lining is shed from the uterine wall. Truth: this isn’t true, but it is preferable not to lie down in a bath to avoid infections. Truth: Not necessarily, unless the irregularity includes delays over several months. Clinical Health Education Department For more information, please contact us by email on: Hpromotion@moh. This article builds on concepts previously presented, which include the abandonment of long-used, ill-de ned, and confusing English-language terms of Latin and Greek origin, such as menorrhagia and metrorrhagia. The terminologies and de nitions described here have been comprehensively reviewed and have received wide acceptance as a basis both for routine clinical practice and for comparative research studies. It is anticipated that these terminologies and de nitions will be reviewed again on a regular basis through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group. This situation has led to rately, primarily because of dif culties in de ning the 5,6 dif culties in interpreting the scienti c and clinical study populations using current terminologies. Indeed, two phase 3 clinical trials on management which primarily addressed the most obvious and con of heavy menstrual bleeding with a novel estradiol-based fusing of issues around terminologies, de nitions, and oral contraceptive, using identical protocols, have just classi cations of abnormal uterine bleeding but also been completed on opposite sides of the Atlantic. Edinburgh, United Kingdom; 3Partnership for Health Analytic Re Semin Reprod Med 2011;29:383–390. It was strongly If these recommendations continue to meet with recommended that poorly de ned and confusing ter wide approval, it is hoped they will be steadily incorpo minologies such as menorrhagia, metrorrhagia,anddys rated into daily professional and community use and be 2,3 functional uterine bleeding be abandoned. Journal editors will be place should be substituted clear and simple terms encouraged to offer guidelines for the use of these that women and men in the general community could terminologies and de nitions in submitted articles. These terminologies partic World Congress of Gynecology and Obstetrics in Cape ularly include several English-language terms with Latin Town in October 2009 and reviewed a series of recom and Greek origins: mendations, which are described here. Many of these recommendations were posed as questions through an ‘‘Menorrhagia’’ is confusingly used as a symptom and audience responder system to a large multicultural audi diagnosis. These audience responses are addressed in recommended to be abandoned as listed in Table 1. It has the methodology behind the recommendations pre mostly been used as a diagnosis of exclusion where the 2,3,7 sented here has been described in detail elsewhere. Menorrhagia (all usages, including ‘‘essential menorrhagia,’’ these issues were then addressed in detailed discussions ‘‘idiopathic menorrhagia,’’ ‘‘primary menorrhagia,’’ and the questions revisited using an audience responder ‘‘functional menorrhagia,’’ ‘‘ovulatory or anovulatory system, in the Delphi process manner. Subsequently Metrorrhagia these recommendations were published (with simulta Hypermenorrhea neous publication in Fertility and Sterility and Human 2,3 Hypomenorrhea Reproduction), and they were also tested in presenta Menometrorrhagia tions at international meetings. This Working Group also assisted in design Epimenorrhagia ing questions to test the acceptability of the recom Metropathica hemorrhagica mended terminologies, de nitions, and classi cations Uterine hemorrhage with a large multicultural audience in the Congress on Dysfunctional uterine bleeding Abnormal Uterine Bleeding Symposium using the 8 Functional uterine bleeding Audience Responder System. Hence it is now recommended lished data from several population studies (2,3) gives a that the diagnoses encompassed within dysfunctional de nition of >20 days in individual cycle lengths over a 11 uterine bleeding can be classi ed under three de nable period of 1 year, which is the de nition we prefer. A very headings: (1) disorders of endometrial origin (disturban detailed analysis of the largest single database gives a ces of the molecular mechanisms responsible for regu de nition of ‘‘a range of varying lengths of bleeding-free lation of the volume of blood lost at menstruation); (2) intervals exceeding 17 days within one 90-day reference 2,13 disorders of the hypothalamic-pituitary-ovarian axis; period. The key characteristics are regularity, that the term oligomenorrhea be abolished. Several abbreviations for these terminolo frequent menstruation and not erratic intermenstrual gies are established or becoming established by increas bleeding; it is very uncommon). The term was understands when a menstrual cycle is irregular, but rst used in New Zealand National Guidelines on Figure 1 the relationships of different types of symptoms and signs of abnormal uterine bleeding using recommended terminologies. These cycles illustrate the characteristics of each type of common pattern in the context of the new recommended terminologies. Women with usually light in volume and is uncommonly associated surface lesions of the genital tract may typically experi with serious pathology (such as intrauterine adhesions ence bleeding during or immediately after sexual inter and endometrial tuberculosis). The term acyclic bleeding is rarely used but encompasses those few women who present with totally erratic bleeding, with no discernable Irregular Nonmenstrual Bleeding cyclic pattern, usually associated with fairly advanced Nonmenstrual bleeding is common and usually consists cervical or endometrial cancer. Premenstrual and post of the occasional episode of intermenstrual or postcoital menstrual spotting (or staining) are descriptions of very bleeding associated with minor surface lesions of the light bleeding that may occur regularly for! Inter symptoms may be indicative of endometriosis or endo menstrual bleeding is de ned as irregular episodes of metrial polyps or other structural lesions of the genital bleeding, often light and short, occurring between oth tract. This bleeding may occasionally be prolonged or heavy, and it may occur on a regular basis around ovulation as a Bleeding Outside Reproductive Age Precocious menstruation (occurring before 9 years of age) is uncommon and usually associated with other Table 2 Acceptable Abbreviations Describing Menstrual Symptoms Established by Popular Usage signs of precocious puberty. The stages of the menopause transition and had to be devised to de ne these new patterns. Twenty-eight or 30-day reference periods may still be used for monthly 8 Acute or Chronic Abnormal Uterine Bleeding hormone systems. Heaviness of ow is dif cult to assess with vention to prevent further blood loss.

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Pain related to cholesterol lowering foods in india tricor 160 mg mastercard the onset of hormone therapy is a common complaint however the etiology of this symptom is unknown cholesterol medication for diarrhea discount 160 mg tricor otc. Acute scrotal contents pain requires a workup to cholesterol levels guide uk cheap tricor 160mg on line rule out conditions requiring emergency treatment cholesterol medication for ibs cheap tricor 160 mg overnight delivery. A physical exam to rule out tumors, hernia, hydrocele or other causes of pain is appropriate. Ready access to transgender surgeries when medically necessary, including orchiectomy and vaginoplasty for the treatment of gender dysphoria, may also minimize this condition. Chronic orchialgia algorithms for non-transgender men often suggest an empirical course of antibiotics (after attempting diagnosing an etiology) and discourage orchiectomy as a last resort measure. Patients often have gender dysphoria and maybe relieved to be offered orchiectomy (as opposed to non transgender men, who are typically resistant to even unilateral orchiectomy when indicated); orchiectomy may be raised much higher in the treatment algorithm in these cases. When orchiectomy is not indicated, medications used in the treatment of neuropathic pain may be June 17, 2016 93 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People useful. Pain related to onset of hormone therapy is generally benign, improves spontaneously, and can be treated expectantly and with reassurance. Providers should not discount testicular pain complaints in transgender individuals, and should avoid any perception that transgender women with this complaint are malingering in hope of obtaining an orchiectomy. June 17, 2016 94 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 18. Army staff noticed that drums of Dow 200 silicone lubricant were disappearing from supply rooms, and traced these drums to providers who were injecting the material. By the 1960s, Dow Chemical had introduced a purified medical silicone (Dow 360), intended for use as a syringe lubricant and as a pharmaceutical vehicle. Subsequent off-label use of Dow 360 was associated with a number of poor outcomes, and by the 1970s some laws had been passed banning the use of such injections. The actual composition of the injected substances is often unknown and may not be of medical grade; contents may include aircraft lubricant, tire sealant, window caulk, mineral oil, methylacrylates, petroleum jelly, or other substances. Additionally, attention sterility and techniques to avoid embolization may be lacking. Large events (“pumping parties”) may take place at which many transgender women receive large volume injections. Motivations for seeking soft tissue injections Motivation for receiving the injections may include a strong desire for immediate body changes to relieve gender dysphoria, especially when other modalities of treatment are, unavailable, inaccessible, or perceived as ineffective or slow. The immediate results may encourage community members to recommend the procedures to their peers before any signs of adverse effects appear. A qualitative study of silicone use in transgender women found four contributing factors to this epidemic: poor self-image, misperceptions about silicone, discomfort in public settings (rapid and extensive feminization from silicone helps transgender June 17, 2016 95 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People women blend or “pass”), and low access to health insurance. Some patients have survived multisystem failure due to this condition with severe disability as sequelae including loss of limbs. Non-inflammatory nodules may also develop causing pain, itching, and abnormal pigmentation. Long term adverse effects occurring weeks to years after the injection include migration of silicone with associated pain or deformity. Local or remote inflammatory and non-inflammatory nodules may develop; some may evolve into sterile abscesses or fistulas. Silicone granulomas may develop, with findings of pain, swelling, ulcerations, lymphadenopathy, and possible systemic constitutional symptoms. Biopsy of such lesions shows foreign body granulomas with white vacuoles and surrounding inflammatory cells. Pathogenesis of these lesions may include T cell activation and the presence of biofilms. Other potential complications include secondary lymphedema, telangiectasias and persistent erythema. Diagnosis A detailed history can help identify any prior soft tissue injections, or risk factors for use. Strategies likely to reduce the prevalence of unlicensed silicone injection include: educating transgender women about risks and alternatives, as well as making available more conventional gender-affirming treatment such June 17, 2016 96 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People as hormones and surgery. Community level interventions, utilizing peer health advocates or promotoras may be more effective than provider-originated interventions. Treatment Approaches: Successful treatment of acute emergencies related to soft tissue injections requires rapid recognition and quick application of intensive care. Delays occur both because of patient hesitation to seek care or report that they received soft tissue injections, and a failure of health care providers to recognize the emergency and to have the knowledge of the necessary treatment. Minocycline shows promise as a first line antibiotic in the setting of infections due to additional anti-inflammatory properties. Liquid injectable silicone: a review of its history, immunology, technical considerations, complications, and potential. Health and social services for male-to-female transgender persons of color in San Francisco. Finding self: A qualitative study of transgender, transitioning, and adulterated silicone. June 17, 2016 97 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 9. The use and correlates of illicit silicone or “fillers” in a population-based sample of transwomen, San Francisco, 2013. Silicon-associated subcutaneous lesion presenting as a mass: a confounding histopathologic correlation. The devastating outcome of massive subcutaneous injection of highly viscous fluids in male-to-female transsexuals. Nonmedical-grade injections of permanent fillers: medical and medicolegal considerations. Granulomatous reaction to liquid injectable silicone for gluteal enhancement: review of management options and success of doxycycline. Hypercalcemia in a male-to-female transgender patient after body contouring injections: a case report. June 17, 2016 98 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 22. Dermolipectomy of the thighs and buttocks to solve a massive silicone oil injection. Managing the mammary gland infiltrated with foreign substances: different surgical alternatives. Surgical management of silicone mastitis: case series and review of the literature. Failure to remove soft tissue injected with liquid silicone with use of suction and honesty in scientific medical reports. June 17, 2016 99 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 19. Although data are limited, there is no evidence that children of transgender parents are harmed in any unique way. Reproduction in transgender persons who have initiated transition and retain their gonads generally involves discontinuation of exogenous hormones, though ovulation and spermatogenesis may continue in the presence of hormone therapy. If an individual has not undergone gonadectomy, and if an initial evaluation demonstrates an absence of ovulation or spermatogenesis, return of fertility may be possible after discontinuing hormone therapy for a period of time. Anecdotally the time to return of fertility can range from 3-6 months, though some may experience permanent loss of fertility, or require assisted technologies as described below. Because infertility is not absolute or universal in transgender people undergoing hormone therapy, all transgender people who have gonads and engage in sexual activity that could result in pregnancy should be counseled on the need for contraception. Gender-affirming hormone therapy alone is not a reliable form of contraception, and testosterone is a teratogen that is contraindicated in pregnancy. It is unknown how long of a testosterone washout period is appropriate in transgender men prior to pregnancy (Grading: X C S). Fertility preservation options may include sperm, oocyte, embryo, ovarian tissue or testicular tissue cryopreservation. Whether long-term hormone exposure confers any unique medical risks to the patient undergoing assisted reproduction procedures or any long-term impact on gametes and to future offspring is currently unknown. Transgender patients who undergo fertility preservation or assisted reproduction should be informed of the lack of data on outcomes. Reproductive options for transgender women In transgender women, research suggests that prolonged estrogen exposure of the testes has been associated with testicular damage.

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If you are taking hormonal pills for the treatment of endometriosis cholesterol absorbing foods trusted tricor 160mg, your parents may have some worries about you taking a pill that is also called the “birth control pill” cholesterol levels diabetes buy 160mg tricor overnight delivery. It’s best to cholesterol levels lower naturally purchase tricor 160 mg with mastercard talk openly with them about how the Pill will stop your periods and help lower your pelvic pain and other discomforts you may have cholesterol za wysoki objawy 160 mg tricor overnight delivery. If your parents have concerns, have them read our health guide “Oral Contraceptive Pills and Teens: A Guide for Parents”. You may not want to tell your friends that you are taking hormonal pills for the treatment of endometriosis. Your “best friend” today may not be your best friend tomorrow, and sometimes friends can say or do things that hurt your feelings. Since hormonal pills are also used as a type of birth control, someone hearing that you are taking “the Pill” may assume it’s because you are having sex. Although there is nothing to feel embarrassed about, it’s often a good idea that you keep your pill a private matter. Adolescent girls and young women are frequently prescribed the oral contraceptive pill just for its medical benefts. These medicines stop your body from ovulating and your endometriosis from growing. Taking synthetic (man–made) progesterone medication in this form is very similar to the natural progesterone that is made by your body during pregnancy. Are there any reasons why I wouldn’t be able to take Progesterone–only hormone therapy You should not take any kind of progesterone if you are pregnant; have cancer, unexplained vaginal bleeding or severe liver disease. You should also tell the team if you have diabetes, high blood pressure, high cholesterol or you have been diagnosed with depression in the past. Most teens and young women have little or no side efects while taking progesterone–only medication. Possible side efects can include breakthrough bleeding or spotting, changes in weight, acne, breast enlargement, feeling bloated, headache/migraines, nausea or vomiting, and possible decrease in bone density (thinning of the bones). Some teens will have very irregular bleeding while taking progesterone–only hormone therapy, especially during the frst 6 months of treatment. Starting Aygestin: Take 1-2 (5mg) tablet at the same time every day as prescribed by your health care provider. At Boston Children’s Hospital, we currently recommend that you do not take more than 10mg of Aygestin/day. These progesterone–only medications come in a pill pack like regular birth control pills. Medroxyprogesterone acetate (Depo–Provera) is an injection that is given in a muscle (in the buttocks, arm or thigh) every 3 months. The frst shot is usually given within the frst 5 days of your menstrual cycle (during your period). Add–back therapy is the addition of a small amount of the hormones estrogen and progesterone or progesterone alone. You must take add–back therapy if you are prescribed Leuprolide acetate (see below). This medication works by shutting of hormones made by your ovaries, so your estrogen (one of the hormones that cause your body to have periods) level is lowered. After your frst injection (shot), your estrogen level will rise before it goes down. Because of this rise in estrogen, you may have an increase in your symptoms for a few weeks. Leuprolide acetate alone is usually prescribed for 6 months (1 shot every 3 months). After a few months of treatment you will have an appointment with your gynecologist to see if the medicine is helping you. This appointment also gives your doctor a chance to ask you about your pelvic pain and any other symptoms you may be having. If your symptoms are better, he may suggest that you continue taking the medicine. Taking Leuprolide acetate alone lowers the estrogen level in the body, which typically causes side efects similar to menopause. These side efects may include: hot fashes, vaginal dryness, decreased interest in sex, moodiness, headaches, spotting, and change in bone density. It is important to get your injections on time and to stop treatment when recommended. Add–back is a pill that contains a small amount of estrogen and progesterone, or progesterone–only that is taken every day. Since hormones are important to keep your bones healthy, low levels of hormones can lower your bone density putting you at risk for osteoporosis (thinning of your bones). The goal of add–back therapy is to give your body back just enough hormone(s) to protect your bones and control any unwanted side efects such as hot fashes and vaginal dryness that are common when taking Leuprolide acetate alone. Your gynecologist will decide on how much add–back medicine you will need, and give you a prescription. The efects of Leuprolide acetate will decrease after you stop taking the medicine. If you’ve been getting Lupron every 3 months, your period will return within 4 to 8 months after your last shot. If you’ve been getting Lupron Depot every month, your period will likely return 6–8 weeks after your last shot. This means that your bones may or may not be as solid as they were before you started the medicine. Research has shown that long term use of Leuprolide acetate alone can cause bone density loss. Bone density loss is a big concern especially if you have a family history of osteoporosis. Weak bones during the teenage years may negatively impact your bone health later in life. It is also important to eat a well–balanced diet and include foods high in calcium. This is a simple test that measures how dense (or thick) your bones are and if your bones are thinning. Calcium works closely with vitamin D and magnesium to build and maintain bone density. Although this medication works by preventing ovulation (stops you from making eggs), there is a rare chance that you could become pregnant if you have unprotected sex. Thus, it is important to use a non–hormonal birth control method such as condoms while on this medication. The long term efects to an unborn baby whose mother was on Leuprolide acetate at the time of conception are unknown at this time, but it does not appear to cause birth defects. It usually takes 2–3 menstrual cycles to see an improvement in symptoms and for your body to get used to the medicine. In the meantime, you can help your body feel better by eating well and getting plenty of rest and exercise. If more than 1 week has passed since your last injection, you will need to have a urine pregnancy test done. After that, you will probably not have anymore vaginal bleeding as long as you take the add–back therapy at the same time each day. Your gynecologist will need to review the results before you can have your next shot. Calcium is also necessary for many of your body’s functions, such as blood clotting and nerve and muscle function. During the teenage years (particularly ages 11–15), your bones are developing quickly and are storing calcium so that your skeleton will be strong later in life. It’s important that you get plenty of calcium in your diet because if the rest of the body doesn’t get the calcium it needs, it takes calcium from the only source that it has: your bones.

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Which one of the following adjunctive thera pies is most appropriate to cholesterol medication examples proven tricor 160mg add to cholesterol test pharmacy safe tricor 160 mg A cholesterol ratio 2.0 buy cheap tricor 160mg. Currently cholesterol medication problems tricor 160mg visa, she is having a heavy menstrual characterized by severe mood-related symptoms. Her hemoglobin concentra has a history of migraines, diet-controlled diabetes, and tion is 7. A 24-year-old woman with a medical history signif icant for depression and alcohol abuse presents to 8. Which one of the following drug regimens is best her physician for her annual physical examination. Bupropion 150 mg orally two times/day continuously throughout the menstrual cycle. Paroxetine 20 mg/day orally dosed is given a diagnosis of polycystic ovary syndrome intermitently during the luteal phase. Her laboratory values are as follows: continuously throughout the menstrual cycle. Fluoxetine 60 mg/day orally dosed ride, 122 mEq/L; blood urea nitrogen, 17 mg/dL; intermitently during the luteal phase. Afer four menstrual cycles with her initial drug ase, 23 international units/L; alkaline phosphatase, 51 international units/L; white blood cells, 5 103 regimen, N. Which one of the following is the one of the following is the best treatment of this best approach to her therapy The sponsive to several treatment modalities, including physician notes oily skin, acne, and excessive facial hair growth. The medi cal care team is considering future treatment options occur at regular 28-day to 30-day intervals. Your patient is a 21-year-old college student who beginning of each menstrual cycle. In addition to her presenting symptoms, which She states that these symptoms usually keep her from one of the following, if present in J. She has experienced menses only four cian’s ofce for her annual physical examination. Her fast mellitus, decreased risk of developing ing lipid profle is within normal limits. Her menstrual endometrial cancer, and decreased need for cycle occurs at regular monthly intervals. Which one of the following is the most appropri improved glucose tolerance, and decreased ate frst-line approach to help improve fertility waist-to-hip ratio. There is no change in her physical examination parameters, but she states that her menstrual cycle is no longer regular. Which one of the following is the most appropriate recommendation to help improve fertility in K. Menstruation is natural & normal Settings and design: Setting of the study is physiological process for all women. Menstruation is Materials and Methods: By using Non a monthly uterine bleeding for 3-5 days, probability purposive sampling technique 60 after 28 days from puberty till menopause. Dysmenorrhoea [3] group 40% each having mild and moderate pain, is a common in adult. The calculated t value shows that recurrent short term absenteeism; from the there is a significant difference between pre test school & worker because it is a severe & and post test effect of cinnamon tea (t28=15. The also responsible for substantial economic unpaired t test shows that there is no significant losses due to the cast of medication, care & [5] difference between cinnamon tea and turmeric lost productivity. Alternative therapy that water in reducing the dysmenorrhea pain sometime decrease dysmenorrhoea include (t58=0. Home administering cinnamon tea with selected remedies for the treatment of demographic variables like family history of dysmenorrhoea are known help to ease off 2 dysmenorrhoea ( =6. Some of the home remedies selected demographic variables like education 2 2 for painful, menstrual period are warm bath, ( =9. Conclusions: the study concludes that exercise, yoga, cinnamon tea & turmeric cinnamon and turmeric both are having equal water. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls [6] Cinnamon is one of the most popular and history of dysmenorrhoea, duration of oldest spices, the bark and leaves of pain and home remedies. It is also scale was used to assess the severity of helpful in relaxing the muscular spasms & pain. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls Statistical Methods between pain scores with selected the descriptive statistics were demographic variables. Paired t test was analyzed by using mean, median, frequency used to find out the difference between pre and percentage. Unpaired t test was used to test and post test pain scores after compare the cinnamon tea and turmeric introducing intervention. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls Table no 3: Shows that selected Table no 4: Shows that selected demographic variable distribution according demographic variable distribution according to frequency and percentage in cinnamon to frequency and percentage in cinnamon tea experimental group. Items Frequency Percentage Before & After the Treatment Of Degree No Age in years Girls. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls Table no 6: Post-test of cinnamon frequency & percentages of Fig no 2: the above line diagram the girls S no Pain Level Score Frequency Percentage revels that out of 30 girls, 6(20%) of them 1 No pain 0 6 20 were had no pain,12(40%) of them were had 2 Mild 1-3 12 40 3 Moderate 4-6 12 40 mild pain,12(40%) of them were had 4 Very severe 7-9 moderate pain. Table no 8: Pre-test level of turmeric water frequency & Table no 8: Represents that 6. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls moderate pain, 6(20%) of them had very Post-test on turmeric water severe pain in pre test. Sl Pain Score Frequency Percentage no level Table no 10: Pre-test & post test of turmeric water 1 No pain 0 1 3. Pre-test & post-test of turmeric water pre-test frequency % pre-test frequency % post test frequency % post test frequency % 73. So with this null hypothesis is rejected and research hypothesis is accepted rejected and research hypothesis is accepted at 0. Table No 14: Association between cinnamon tea group with selected demographic variables S no Variables 2 value df Significance Remarks 1 Age in years 3. So remaining of cinnamon tea experimental group girls selected demographic variables is not selected demographic variable like family having association with pain scores. Table No 15: Association between turmeric water group with selected demographic variables S no Variables 2 value df Significance Remarks 1 Age in years 1. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls Table No 15: Represents that there is a 76 females student received placebo significant association between pain scores (n=38), capsules containing starch or of turmeric water experimental group girls cinnamon (n=38, capsules contain 420 selected demographic variables like family mg cinnamon). Among 60 hostel girls the lifestyle and remaining selected dysmenorrhea level was calculated. No demographic variables is not having pain (0), mild pain(1-3), moderate pain(3 association with menstrual pain (Anil 7), severe pain (7-10),then worst pain (10). The cinnamon tea and turmeric family history of dysmenorrhoea water shows significant reduction in 2 dysmenorrhea individually. The study concludes that demographic variables is not having cinnamon and turmeric both are having association with pain scores in equal effectiveness to reduce cinnamon tea group dysmenorrhoea. So An exploratory and descriptive study may remaining selected demographic be undertaken to assess the prevalence dysmenorrhoea among degree girls variables is not having association with An exploratory and descriptive study may pain scores in turmeric water group be conducted to assess the copy strategies A randomized double blind trial was used by the girls to manage conducted at Iran to assess the effect of dysmenorrhoea cinnamon on primary dysmenorrhea. Effectiveness of Cinnamon Tea and Turmeric Water for Reducing Dysmenorrhoea among Degree Girls A descriptive study may be conducted to 3. Suda T,Premenstrual syndrome among assess the factors influence the prevalence women in reproductive age, Nightingale of severity of dysmenorrhoea girls Nursing times,2011. C, Text book of Gynecology, 4 to assess the effectiveness of vitamin d1 in edition. Herdwiani W, Soemardji Aa And participants for helping me to undertake, this Elfahmi. Effectiveness of cinnamon tea knowledge of menstrual problems, and turmeric water for reducing Nightingale Nursing times, 2011. Please copy this diary if you need to record your symptoms for more than one week. Please answer as honestly as you can – your answers will be invaluable for your doctor. Don’t just answer ‘yes’ or ‘no’ but try to provide as much information as you can. Did you take or do Week Are you How does it feel** and bloating, bleeding, anything to help with beginning on your Describe your pain* how long does it last Where 1 = tolerable and 10 = the worst pain imaginable ** Please use the words listed on question 6 under “pain”, or add your own *** Please state whether these symptoms affected your work, education, relationships, social activities, sleep, exercise, food intake, sex life, stress levels, quality of life that day Registered Charity No.

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