International Journal of Reproduction, Contraception, Obstetrics and Gynecology

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https://imsear.searo.who.int/handle/123456789/149634

Editor in Chief: Dr. Bhaven Kataria

Print ISSN: 2320-1770 (Print)

Frequency: 4 issues a year

Language: English

Open Access Peer-reviewed journal

Web site: https://www.ijrcog.org/index.php/

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Now showing 1 - 20 of 3505

Measurement of serum vitamin D levels among the pregnant women
(Medip Academy, 2025-07) Pervin, S; Dhar, JR; Sultana, N; Ahmed, B; Khanam, MN; Haque, MM; Susan, ZS; Chowdhury, TA.
Background: Endometriosis is a significant cause of infertility, particularly among women of reproductive age. It often presents with symptoms such as pelvic pain, dysmenorrhoea, and dyspareunia. Laparoscopy is still the gold standard for diagnosing and staging endometriosis. This study aimed to determine the frequency of endometriosis among infertile women undergoing diagnostic laparoscopy and to assess the association of clinical symptoms with disease severity. Methods: A cross-sectional descriptive study was conducted at the Center for Assisted Reproduction (CARE), BIRDEM General Hospital, Dhaka, Bangladesh, from July 2013 to June 2015. A total of 127 infertile women, both primary and secondary, undergoing diagnostic laparoscopy and dye test were enrolled. Data were analyzed using SPSS version 20, with a p-value <0.05 considered statistically significant. Results: Endometriosis was detected in 18.9% of participants. The mean age was 29.31±4.08 years. Most women had normal (36.22%) or overweight (34.65%) BMI. Secondary infertility was more common (71.65%), but endometriosis was significantly associated with primary infertility (p=0.004). Clinical symptoms, including severe dysmenorrhoea, chronic pelvic pain, and dyspareunia, were significantly associated with endometriosis (p<0.05). Stage II endometriosis was significantly linked with chronic pelvic pain and moderate to severe dysmenorrhoea (p=0.002, 0.004), while stage IV was associated with severe dysmenorrhoea, menorrhagia, and dyspareunia (p=0.016, 0.004, 0.010, respectively). Menorrhagia had an inverse association with endometriosis overall. Conclusions: Endometriosis is more frequently associated with primary infertility and specific pelvic symptoms, particularly at advanced stages. Laparoscopy remains essential for accurate diagnosis and staging.
Measurement of serum vitamin D levels among the pregnant women
(Medip Academy, 2025-07) Sharmin, SN; Das, TR; Fatema, J; Rahman, I; Noor, F; Islam, S; Chakma, B; Chowdhury, TI
Background: Vitamin D deficiency during pregnancy has been implicated in adverse maternal and neonatal outcomes, including preterm labor. However, study on serum vitamin D status among pregnant women remains limited in the local context. This study aimed to assess the serum vitamin D levels among pregnant women presenting in labor and to explore associations with sociodemographic, behavioral, and obstetric factors. Methods: A descriptive type of cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, Bangladesh Medical University (BMU), Dhaka, from July 2023 to June 2024. A total of 64 pregnant women aged 18-40 years in labor were enrolled, Data were collected using a semi-structured questionnaire. Serum 25(OH) vitamin D levels were measured using the Atellica IM assay. Statistical analysis was performed using SPSS version 26 with significance set at p?0.05. Results: The mean age of participants was 34.86±9.64 years. Most women were housewives (40.6%) and had completed primary, secondary, or higher secondary education (each 28.1%). Approximately 65.6% were primiparous, 45.3% were at 37-38 weeks of gestation, and 25.0% reported pregnancy complications. While 71.9% received vitamin D supplements, 34.4% had low intake of dairy/fish, and 89.1% had ?30 minutes of daily sun exposure. The BMI assessment showed 29.7% were overweight and 20.3% obese. Vitamin D insufficiency was observed in 90.6% of participants. Significant associations were found between serum vitamin D levels and parity (p =0.000) as well as gestational age (p =0.000). Conclusions: Vitamin D insufficiency is highly prevalent among pregnant women in labor, particularly in primiparas and those with preterm labor. Findings highlight the need for targeted nutritional interventions and routine vitamin D screening during antenatal care.
Bayesian logistic regression of stillbirth cases in the Bolgatanga Municipality of Ghana, West Africa
(Medip Academy, 2025-07) Zamanah, E; Nasiru, S
Background: Stillbirth, as an adverse outcome of pregnancy, represents a growing worldwide public health challenge. The risks of stillbirth have been reported to exhibit considerable variation across different factors due to variability in socio-economic and geographical settings. Thus, this study was aimed at modelling the risk of stillbirth in the Bolgatanga Municipality of the Upper East region of Ghana and identifying some possible risk factors. Methods: A retrospective cohort study design was utilized in this work. Thus, all the data were obtained from the medical recorded histories of all single birth outcomes at Bolgatanga Regional hospital in Ghana from September 2023 to December 2024. Bayesian logistic regression was applied in fitting the data on stillbirth in this study. R studio was the statistical software that was utilized in analysing the data. Results: Based on the results of the posterior estimation of the Bayesian logistic regression, maternal age, educational level and hypertension status were established as significant risk factors of stillbirth in the Bolgatanga Municipality. Overall, women with low maternal age (<20 years) and those with advanced maternal age (?35 years), women with no formal education, and women with hypertension during pregnancy were established to have a higher risk of stillbirth in the Bolgatanga Municipality. Conclusions: The study concluded by indicating the need for various agencies of healthcare in the Bolgatanga Municipality to institute targeted interventions that will help control the effects of the risk factors and enhance improved overall pregnancy outcomes.
Maternal and neonatal outcome in gestational and pregestational diabetes
(Medip Academy, 2025-07) Sultana, N; Pervin, S; Khanam, N; Haque, M; Ahmed, N; Rahman, S
Background: Diabetes during pregnancy increases risks for both mother and baby, despite medical advances. This study evaluates and compares maternal and fetal outcomes in pre-gestational and gestational diabetes. The aim of the study was to evaluate the maternal and perinatal outcomes in patients with gestational and pre-gestational diabetes. Methods: This prospective cross-sectional study was conducted at the department of obstetrics and gynecology, BSMMU, and BIRDEM, Dhaka, Bangladesh, from January 2004 to December 2005, involving 150 pregnant women divided into three groups: 50 non-diabetics, 50 with pre-existing diabetes (PDM), and 50 with gestational diabetes (GDM). Data were collected using a structured questionnaire and analysed with SPSS, applying Chi-square and t-tests. Results: Maternal age and weight were similar across groups (p>0.10). Diabetic patients had significantly more pregnancy complications (66-68%) than non-diabetics (28%) (p<0.05), with higher insulin use in pre-gestational diabetes (90%) (p<0.01). Operative deliveries and post-partum issues were more common in diabetics, though not statistically significant. Pregnancy losses were higher in diabetic groups (14% and 6%) vs. none in non-diabetics (p<0.05). Neonatal resuscitation (65.1%, 59.6%) and morbidities (50%, 38%) were also more frequent in diabetics than in non-diabetics (42% and 20%) (p<0.05). Conclusions: Well-controlled diabetes, whether pre-gestational or gestational, still poses increased maternal and perinatal risks compared to non-diabetic pregnancies, but with proper preconception management, favourable outcomes are achievable.
Breast cancer screening: a narrative review
(Medip Academy, 2025-07) Kaundal A., Bhavna
Breast cancer (BC) is the most commonly diagnosed cancer and a leading cause of cancer-related mortality among women worldwide, accounting for over 2.5 million cases and 670,000 deaths annually. The burden is disproportionately higher in low- and middle-income countries (LMICs) due to limited access to screening, poor infrastructure, low awareness, and socio-cultural barriers. Early detection through screening plays a critical role in improving survival and reducing morbidity. This review outlines the epidemiology of breast cancer (BC), stratification of risk, and current international and national screening guidelines. Various screening modalities are discussed, including mammography, ultrasound, MRI, clinical breast examination (CBE), and emerging technologies such as artificial intelligence and liquid biopsy. The role of innovative tools such as the iBreastExam and, community-based strategies in resource-limited settings is emphasized. Despite advances, key challenges remain regarding accessibility, affordability, and awareness.
When endometriosis returns: managing vault involvement after hysterectomy: a case report
(Medip Academy, 2025-07) Sinha, A; Rahane, TL; Ghorpade, N.
Vault endometriosis is a rare but quite challenging condition occurring in post-hysterectomy patients. Minimally invasive surgery remains the gold standard for the diagnosis and management of such cases. We hereby present a case report of a 41-year-old lady who had undergone total laparoscopic hysterectomy 12 years ago and came with irregular vaginal bleeding since 7 to 8 years. She was thoroughly evaluated for the same and underwent biopsy of the growth over the vault, which was suggestive of endometriosis. Magnetic resonance imaging (MRI) was done to rule out involvement of the bladder and rectum. She underwent elective laparoscopic excision of an endometriotic nodule over the vault and bladder serosal shaving. Postoperatively patient was relieved of her signs and symptoms.
Spontaneous hemoperitoneum in pregnancy: a rare case report
(Medip Academy, 2025-07) Singh, A; Aggarwal, K; Krishna, N; Sinha, S; Lal, P
Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but life-threatening condition with an estimated incidence rate of 0.04 per 1000 births. It is characterized by the accumulation of blood in the peritoneal cavity without trauma or obvious cause in pregnancy and up to 42 days postpartum that lead to significant maternal and perinatal complications. SHiP mostly occurs in third trimester of pregnancy with an incidence of 27% in the second trimester. A 40-year-old multigravida female at 30 weeks of gestation who presented with acute abdominal pain. Urgent imaging revealed a small amount of free fluid in perihepatic and perisplenic space with blood clots highly suggestive of hemoperitoneum. An emergency laparotomy was performed which confirmed the diagnosis and approximately 1-1.5 litres of hemoperitoneum with 1 litre of blood clot from pouch of douglas were evacuated. Caesarean section was performed at the same time placenta was delivered with intact membranes. There was atonic post-partum haemorrhage (PPH) which was not medically managed, so in view of doubt of rent in lower uterine segment with increased vascularity over the post surface, atonic PPH and general condition of the patient, total abdominal hysterectomy was done. Total blood loss was 3.5 litres. Both mother and baby recovered without further complications. This case highlights the importance of early recognition and prompt surgical intervention in SHiP to prevent maternal and fetal morbidity and mortality. Given its rarity and non-specific presentation, SHiP remains a diagnostic challenge and requires a high index of suspicion in pregnant women with acute abdomen and hemodynamic instability.
A rare case report of septuple nuchal cord entanglement with favourable perinatal outcome
(Medip Academy, 2025-07) Krishnamoorthy, SM; Natarajan, U.
A nuchal cord refers to the umbilical cord being looped one or more times around the fetal neck. While often a common finding during pregnancy and labor without adverse effects, it can sometimes lead to complications, including variable decelerations in fetal heart rate, reduced fetal movement, signs of fetal distress, and, rarely, intrauterine fetal demise (IUD). This case describes a rare instance of seven loops of the umbilical cord encircling the fetal neck, identified during a cesarean section in a woman who presented with labor pains at 37 weeks and 1 day of gestation. The pregnancy was complicated by gestational diabetes and polyhydramnios. Intrapartum fetal surveillance revealed recurrent variable decelerations on cardiotocography and the presence of grade 2 meconium-stained liquor. Intraoperatively, seven tight loops of the umbilical cord were observed wrapped around the fetal neck, with a cord length of 115 cm. The fetal and maternal outcomes in cases of nuchal cord entanglement depend on various factors, including the number of loops, cord length, coiling tightness, and amniotic fluid index. Careful intrapartum monitoring and prompt interventions can improve perinatal outcomes, even when nuchal cord entanglement is not diagnosed prenatally. Managing nuchal cord entanglement remains challenging. Although multiple loops (more than five) are rare, we report an uncommon instance of seven loops of nuchal cord entanglement, which resulted in favorable maternal and fetal outcomes.
Clinical management and successful pregnancy outcomes in women with empty Sella syndrome undergoing assisted reproductive technology: a case-based approach
(Medip Academy, 2025-07) Mariyappan, S; Anand, PP.
Empty Sella syndrome (ESS) is a radiological condition characterized by a partially or completely flattened pituitary gland within the sella turcica, which may impact reproductive function. This case report presents two women with ESS undergoing in vitro fertilization (IVF). Despite having ESS, patient A had a normal ovarian reserve and conceived after frozen embryo transfer (FET) and regulated ovarian stimulation. Patient B needed an oocyte donation program in order to achieve pregnancy because of their significantly reduced ovarian reserve (AMH=0.01 ng/ml). The fact that both patients were able to conceive shows how important it is to use customized assisted reproductive technology (ART) plans depending on ovarian function. ESS presents a heterogeneous impact on fertility, necessitating tailored treatment plans, including optimized ovarian stimulation, embryo transfer protocols, and donor oocyte utilization. A multidisciplinary approach involving reproductive endocrinologists and fertility specialists is crucial in managing ESS-related infertility to maximize pregnancy success.
Successful pregnancy outcome in uncorrected tetralogy of Fallot with bidirectional shunt
(Medip Academy, 2025-07) Tauro, SR; Devi, RP; Sen, S; Rout, A; Nayak, A
Tetralogy of Fallot (TOF), a cyanotic congenital heart disease, is the most prevalent type, constituting 10% of all congenital heart conditions. During pregnancy and childbirth, patients with uncorrected TOF can experience deterioration, posing a significant risk to maternal health and even mortality. A 30 year old patient was referred from a private clinic in view of uncorrected TOF in the third trimester of pregnancy. She was G3P1A1 who reported at 37 weeks 2 days period of gestation to the emergency room with history of breathlessness on routine activities for 10 days (NYHA III) and easy fatigability for 4-5 months and pain abdomen. Her previous antenatal and pre pregnancy period was uneventful with no history of cyanotic spells, dyspnea or palpitations. Electrocardiography showed sinus rhythm, right atrial enlargement, right ventricular hypertrophy with sudden transition of QRS in V2. Her echocardiography confirmed the findings of TOF. It revealed a large peri membranous VSD with bidirectional shunt with 50% overriding of aorta. There was non dysplastic severe pulmonary stenosis, right ventricular outflow tract narrowing with right ventricular hypertrophy, severe pulmonary hypertension, with a left ventricular ejection fraction of 56%. She underwent emergency cesarean section under general anesthesia in joint consultation of the obstetrics unit along with anesthesiologist, cardiologist, intensivist and neonatologist. Her cardiovascular status was never compromised. She was started on torsemide and was discharged on 6th post-operative day. She followed up with cardiologist after 4 weeks postpartum for further management.
A case report of adult onset nephrotic syndrome in pregnancy
(Medip Academy, 2025-07) Budhewar, A; Ubale, S; Senapati, J; Gurjar, R
Proteinuria in pregnancy is one of the most common issues encountered on a routine basis, mostly thought due to preeclampsia. However, there are plethora of reasons for proteinuria other causes of the same should also be thought while diagnosing and managing proteinuria. One of the causes of massive proteinuria is nephrotic syndrome. Nephrotic syndrome is a clinical syndrome defined massive proteinuria responsible for hypoalbuminemia resulting in hyperlipidemia edema and various complications. It is caused by increased permeability through damaged basement membranes in renal glomeruli. Nephrotic range of proteinuria defined as urinary loss of 3 gm or more protein/ 24 hours or presence of 2 gm of protein per gram of creatinine in spot urinary samples. Here is a case report of nephrotic syndrome in pregnancy managed by a multidisciplinary approach with successful outcome.
Breast cancer in reproductive-age women: oncofertility perspectives, treatment impact, and fertility preservation strategies
(Medip Academy, 2025-07) Chadha, S
Breast cancer remains the most prevalent malignancy among females globally, comprising 12.5% of all cancer cases. While the median age of diagnosis in Western populations is 62 years, India reports a significantly younger median age of approximately 49 years, correlating with its youthful demographic profile. The incidence of breast cancer in women of reproductive age- approximately 19.3 per 100,000- has been rising steadily, necessitating urgent attention to fertility preservation in this population. Cancer treatments such as gonadotoxic chemotherapy, endocrine therapy, and radiation can adversely affect ovarian reserve, delay childbearing, or induce premature ovarian insufficiency. Consequently, fertility preservation has emerged as a crucial component of cancer care for young survivors. Oncofertility, an evolving interdisciplinary field, integrates oncology and reproductive medicine to provide comprehensive fertility counselling and interventions for cancer patients. Despite the growing importance of fertility preservation, barriers such as inadequate referral, limited awareness, financial constraints, and concerns regarding delays in cancer treatment or hormonal stimulation in hormone-positive cases hinder access. The impact of treatment on fertility varies depending on age, ovarian reserve, and treatment modality. Options for fertility preservation include embryo cryopreservation, mature and immature oocyte freezing, ovarian tissue cryopreservation, and temporary ovarian suppression using GnRH agonists. The National Comprehensive Cancer Network (NCCN) recommends early fertility discussions for all premenopausal breast cancer patients. In addition, pregnancy-associated breast cancer (PABC), though rare, presents a clinical challenge due to diagnostic delays and treatment limitations during gestation. As survival rates improve, safeguarding reproductive potential becomes vital to the quality of life of young survivors. Individualized, timely fertility preservation strategies supported by national and international guidelines are key to improving outcomes in reproductive-age women with breast cancer.
A case of haloperidol induced neuroleptic malignant syndrome in postpartum psychosis: a rare case report and review of literature
(Medip Academy, 2025-07) Meganathan, J; Thirupathi, K.
Neuroleptic malignant syndrome (NMS) is a very rare and fatal complication which occurs due to use of Neuroleptic agents in the treatment of psychotic disorders. Neuroleptic drugs are assumed to be safe for both mother and foetus owing to its relative impact on untreated fulminant psychosis. NMS was observed mostly after the use of high potency first generation neuroleptic agents such as haloperidol, fluphenazine, chlorpromazine. NMS is characterised by triad of fever, muscle rigidity and altered mental status. We report a case of 26 years old G2P1L1 pregnant woman presented with abruptio placentae and intrauterine foetal demise at 35 weeks of gestation. During postpartum period, she developed NMS due to usage of haloperidol for postpartum psychosis. In this case we achieved a prompt recovery by using bromocriptine and lorazepam.
Preventing ureteric injury in total laparoscopic hysterectomy: a focus on surgical technique
(Medip Academy, 2025-07) Sarwar, S; Khattak, A; Khattak, N; Islam, M; Zarin, M
Hysterectomy is a frequently performed procedure in gynaecology. Laparoscopic hysterectomy offers the added advantages of reduced postoperative pain, minimal blood loss, shorter hospital stays, and lower incidence of surgical site infections. However, it does carry an elevated risk of injury to the urinary bladder and ureters. Recent technological advancements can help identify the ureters during laparoscopic hysterectomy, thereby decreasing the occurrence of lower urinary tract injuries. However, these advanced techniques are often not easily accessible in developing countries and can be expensive. We described a step-by-step approach to total laparoscopic hysterectomy that aims at minimising the risk of lower urinary tract injuries, and recent advances along with other methods to avoid urinary tract injuries are also discussed.
Conservative laparoscopic approach to paratubal cyst torsion in young girls: three cases of preserved fertility
(Medip Academy, 2025-07) Dubey, K; Choudhury, S; Gedam, P; Mangani, D; Gupta, A
Paraovarian and paratubal cysts, constituting approximately 10% of all adnexal masses, are typically benign and originate from the mesothelial lining or remnants of the Müllerian and Wolffian ducts. Although the incidence of torsion is lower in paraovarian cysts compared to ovarian cysts, it presents notable challenges, particularly in young women where fertility preservation is crucial. This report discusses three cases of torsed paratubal cysts successfully managed through laparoscopic techniques designed to prioritize fertility preservation. The surgical approach emphasized careful detorsion, aspiration of cyst contents for ease of manipulation, and the avoidance of energy devices during dissection to maintain vascular integrity in the ovaries and fallopian tubes. A strategic incision placed away from the fallopian tube further minimized the risk of injury, thereby safeguarding reproductive potential. Postoperative outcomes demonstrated effective pain relief, with histopathological findings of serous cystadenoma underscoring the importance of meticulous surgical techniques in preserving reproductive function in young patients.
Cervical heterotopic pregnancy: a rare occurrence
(Medip Academy, 2025-07) Sharma, VM; Hitnalikar, P; Babu, S.
Ectopic pregnancy is one of the leading causes of first-trimester gestation-related mortality. Cervical ectopic is a rare entity (less than 1% of all ectopic cases), heterotopic cervical pregnancy is a much rarer occurrence. Cervical pregnancy is highly dangerous and demands immediate termination of pregnancy as the chances of haemorrhage are too high, leading to maternal mortality. Although there are various approaches to terminate cervical pregnancy, it is challenging when accompanied by a live intrauterine pregnancy. Ultrasound-guided transcervical aspiration of the products of conception is the most suitable option in these cases. Here we describe a case of cervical heterotopic pregnancy, which we successfully and safely terminated using the above approach.
Successful management of a young patient with endometroid ovarian carcinoma with positive immuno-histochemistry
(Medip Academy, 2025-07) Shetty, C; Satia, M; Bhadhwar, V; Yelurkar, N
Ovarian cancer is overall a disease of postmenopausal women although, in about 12% of cases, it may develop during child bearing age. This estimate includes numerous women with borderline and non-epithelial tumours typically presenting during child bearing age group. Although there are several case reports of Endometriosis-associated ovarian cancer (EAOC) at a young age, the exact age distribution of EAOC diagnosis is still not well- expounded. Presenting here with a young patient with ovarian malignancy with positive immuno-histochemistry for both oestrogen and progesterone receptor.
Isolated tubal ischemia secondary to small bowel volvulus: a rare case report
(Medip Academy, 2025-07) Boukroute, M; Regragui, A; Chatbi, Z; Bellajdel, I; Taheri, H; Saadi, H; Mimouni, A.
Torsion of the fallopian tube is a rare cause of acute abdominal pain, often underrecognized in the context of intestinal pathology. We reported the case of a 30-year-old woman who developed isolated fallopian tube ischemia secondary to small bowel volvulus, a complication rarely described. She presented with acute hypogastric pain, vomiting, and mild left hydronephrosis. CT imaging revealed a small bowel obstruction with a whirlpool sign but no apparent tubal abnormalities. Laparotomy identified a twisted, ischemic fallopian tube with hydrosalpinx, attributed to adhesions from a recent appendectomy. Salpingectomy, small bowel resection, and anastomosis were performed, with histopathology confirming ischemic necrosis. This case underscores the diagnostic challenge posed by overlapping gastrointestinal and gynecological emergencies and suggests that vascular compromise in small bowel volvulus may extend to pelvic structures. Given the rarity of secondary tubal torsion, clinicians should consider this possibility in women with prior pelvic surgery and acute abdominal pain. Early CT imaging and interdisciplinary collaboration are essential for timely intervention and improved outcomes.
Overcoming poor ovarian reserve: a case report series of spontaneous conception after failed intracytoplasmic sperm injection
(Medip Academy, 2025-07) Mariyappan, S; Anand, PP
This case report addresses the possibility of spontaneous conception in women with diminished poor ovarian reserve (POR) after multiple failure of assisted reproductive technology (ART) cycles, including intrauterine insemination (IUI) and intracytoplasmic sperm injection (ICSI). Four cases were analyzed, including patients aged 31 to 41 years, each with a unique clinical profile for POR. These patients were infertile for durations of 5 to 12 years, as well as with other conditions like hypothyroidism and raised BMI. Recombinant FSH was used in all cases for ovarian stimulation, but the outcome was suboptimal with poor oocyte retrieval rates and fertilization failure. The cumulative follicle-stimulating hormone (FSH) dose used in patients ranged from 1875 IU to 3000 IU. This strategy produced a low yield of oocytes, most of which were immature or failed to fertilize. Remarkably, all four patients subsequently conceived spontaneously and gave birth to healthy babies without additional ART treatments, despite the difficulty encountered in the ART cycles. The observation that spontaneous conception was successful in these complicated cases underscores the need for further studies into the mechanisms underlying such events to occur, especially in patients who have had multiple failure with ART. This case report underscores the merit of individualized treatment strategies and continued investigation into the determinants influencing fertility in women with POR.
Endometrial polyp-induced fallopian tube obstruction
(Medip Academy, 2025-07) Moallim, A. O
Endometrial polyps are common non-cancerous growths in the uterine lining, leading to unusual bleeding and fertility issues. These generally lack symptoms, but can cause heavy periods, bleeding between cycles, and fertility struggles. Diagnostic methods include hysterosalpingography, hysteroscopy, and histopathological examination. This report covers a 30-year-old woman with irregular cycles and infertility for seven years, diagnosed with an endometrial polyp blocking the fallopian tubes. After a hysteroscopic polypectomy, she experienced symptom relief and her menstrual cycle normalized.

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