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Obesity and menstrual disorders

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Abstract

Obese women often present with oligomenorrhoea, amenorrhoea or irregular periods. The association between obesity and heavy menstrual bleeding is not well documented and data on its prevalence are limited. While the investigation protocols should be the same as for women of normal weight, particular focus is required to rule out endometrial hyperplasia in obese women. The treatment modalities of menstrual disorders for obese women will be, in principle, similar to those of normal weight. However, therapeutic outcomes in terms of effectiveness and adverse outcomes need special consideration when dealing with women with a high body mass index (BMI). Here, different treatment strategies are reviewed paying particular attention to the effect of weight on their efficacy and the challenges of providing each treatment option. This chapter aims to review the current literature and address areas where further evidence is needed, which will subsequently influence clinical practice. Copyright © 2014. Published by Elsevier Ltd.

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... www.nature.com/scientificreports/ Obese women with AUB-O are at high risk for developing endometrial neoplasia and may benefit from preventive measures 18 . Although authorities recommend that endometrial biopsy should be performed in women older than 45 years 19,20 , obese women may need endometrial biopsy at a younger age 18 . ...
... Obese women with AUB-O are at high risk for developing endometrial neoplasia and may benefit from preventive measures 18 . Although authorities recommend that endometrial biopsy should be performed in women older than 45 years 19,20 , obese women may need endometrial biopsy at a younger age 18 . Our study population was slightly younger than 45 years, but they had BMI in the overweight to obese classification according to the WHO Asia Pacific BMI cut point (≥ 23 kg/M 2 ) 21 . ...
... Our study population was slightly younger than 45 years, but they had BMI in the overweight to obese classification according to the WHO Asia Pacific BMI cut point (≥ 23 kg/M 2 ) 21 . The preventive measures for these women include bodyweight reduction by lifestyle modification and progestin therapy 18 . ...
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Women with chronic abnormal uterine bleeding-ovulatory dysfunction (AUB-O) are at increased risk of endometrial neoplasia. We conducted a non-inferiority randomized controlled trial to determine the effectiveness of two cyclic-progestin regimens orally administered 10 d/month for 6 months on endometrial protection and menstruation normalization in women with AUB-O. There were 104 premenopausal women with AUB-O randomized to desogestrel (DSG 150 µg/d, n = 50) or medroxyprogesterone acetate (MPA 10 mg/d, n = 54) group. Both groups were comparable in age (44.8 ± 5.7 vs. 42.5 ± 7.1 years), body mass index (24.8 ± 4.7 vs. 24.9 ± 4.7 kg/m ² ), and AUB characteristics (100% irregular periods). The primary outcome was endometrial response rate (the proportion of patients having complete pseudodecidualization in endometrial biopsies during treatment cycle-1). The secondary outcome was clinical response rate (the proportion of progestin withdrawal bleeding episodes with acceptable bleeding characteristics during treatment cycle-2 to cycle-6). DSG was not inferior to MPA regarding the endometrial protection (endometrial response rate of 78.0% vs. 70.4%, 95% CI of difference − 9.1–24.4%, non-inferiority limit of − 10%), but it was less effective regarding the menstruation normalization (acceptable bleeding rate of 90.0% vs 96.6%, P = 0.016). Clinical trial registration : ClinicalTrials.gov (NCT02103764, date of approval 18 Feb 2014).
... There is potential for this phenomenon of delayed access to health services among obese populations to extend into antenatal care, although this is an under explored area of research. From a physiological perspective, both underweight and obesity can contribute to irregular menstruation including oligomenorrhoea, amenorrhoea and irregular uterine bleeding [32,33] which may contribute to delayed realisation and confirmation of pregnancy, and subsequent delayed access to care. ...
... A further London-based study also identified that teenagers and multiparous women accessed care beyond 18 weeks, but the authors reported a high level of missing BMI data [38]. A recent review of the pathophysiology of obesity and menstrual disorders identified that obesity, especially central adiposity, was associated with increased oestrogen levels, circulating free testosterone, and with insulin levels which stimulates the production of androgens in ovarian tissue which can cause disruptions to normal ovulation and menstrual bleeding [32]. Additionally, the association with menstruation disturbances was stronger for early onset obesity potentially due to the leptin levels which regulates the gonadotropin surge initiating pubertal stages [32]. ...
... A recent review of the pathophysiology of obesity and menstrual disorders identified that obesity, especially central adiposity, was associated with increased oestrogen levels, circulating free testosterone, and with insulin levels which stimulates the production of androgens in ovarian tissue which can cause disruptions to normal ovulation and menstrual bleeding [32]. Additionally, the association with menstruation disturbances was stronger for early onset obesity potentially due to the leptin levels which regulates the gonadotropin surge initiating pubertal stages [32]. The association with menstrual disturbances may further contribute to late access to antenatal care due to delayed realisation about conception, particularly among women with central adiposity, or those who developed obesity during childhood. ...
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Background Late access to antenatal care increases risks of adverse outcomes including maternal and perinatal mortality. There is evidence that BMI influences patient engagement with health services, such as cancer screening services and delayed access to treatment; this association has not been fully explored in the context of antenatal care. This study investigated the association between the stage of pregnancy women access antenatal care, BMI, and other socio-demographic factors. Methods Retrospective analysis of routine hospital data from 34 NHS maternity units in England, UK, including 619,502 singleton births between 1989 and 2007. Analyses used logistic regression to investigate the association between maternal BMI categories and stage of pregnancy women accessed antenatal care. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were used to estimate associations, adjusting for maternal age, ethnic group, parity, Index of Multiple Deprivation score and employment status. The primary outcome was late access to antenatal care (>13⁺⁶ weeks). Secondary outcomes were trimester of access, and the association between late access and other socio-demographic variables. Results Women with an overweight or obese BMI accessed antenatal care later than women with a recommended BMI (aOR 1.11, 95%CI 1.09–1.12; aOR 1.04, 95%CI 1.02–1.06 respectively), and underweight women accessed care earlier (aOR 0.77, 95%CI 0.74–0.81). Women with obesity were 42% more likely to access care in the third trimester compared with women with a recommended BMI. Additional significant socio-demographic associations with late access included women from minority ethnic groups, teenagers, unemployment and deprivation. The greatest association was observed among Black/Black British women accessing care in the third trimester (aOR 5.07, 95% CI 4.76, 5.40). Conclusions There are significant and complex socio-demographic inequalities associated with the stage of pregnancy women access maternity care, particularly for women with obesity accessing care very late in their pregnancy, and among BME groups, teenagers, deprived and unemployed women. These populations are at increased risk of adverse maternal and fetal outcomes and require support to address inequalities in access to antenatal care. Interventions to facilitate earlier access to care should address the complex and inter-related nature of these inequalities to improve pregnancy outcomes among high-risk groups. Electronic supplementary material The online version of this article (10.1186/s12884-017-1475-5) contains supplementary material, which is available to authorized users.
... Obesity is considered a growing public health problem as it is associated with many comorbidities (1). It is also closely related to women's health and affects it negatively. ...
... It is also closely related to women's health and affects it negatively. Obesity in women causes menstrual irregularities, chronic oligo-anovulation, pregnancy complications and infertility as a result of various hormonal abnormalities such as increased testosterone and insulin concentrations and decreased sex hormone binding globulin (SHBG) concentration (1,2). The most important gynecological and obstetric problems triggered by obesity in obese young girls (OYG) are menstrual symptoms (3,4). ...
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Aim: Planned trainings focused on a specific health problem can promote health behaviors and healing illnesses symptoms. This study was conducted to evaluate the effect of "Healthy lifestyle behaviors and menstruation (HLB-MENS)" training given according to the Health Promotion Model (HPM) in order to improve the menstrual symptoms of adolescent obese girls. Method: This randomise controlled intervention study was conducted from September 1, 2017 to January 21, 2018. Since the obese group would be composed of sensitive individuals, an improbable-random sampling method was used in the first stage. In the second stage, randomized assignment from volunteers was performed. The study included 9th, 10th, and 11th-grade obese girls in high schools. They divided two groups as intervention (n=63) and control (n=65) (power of 80.1%, p = <0.05, effect size = 0.80). The intervention group received 16 weeks of planned training, the control group was not included in the training. The training consisted of three different titles. The lessons were held in two stages as basic training and reinforcement training. Participants took a total of 7 hours of lessons on each subject. Results: Positive developments in healthy lifestyle behaviors improved the obese girls' mentural symptoms. In the intervention group MSQ total scores(p<0.007) and menstrual pain decreased(p < 0.001). HLBS-II total scores(p<0.001), and physical activity subscale scores(p<0.026.) were increased. The rates of walking, physical activity behaviours and physical activity duration increased above 4 h,(p<0.001). Difficulty in walking from daily activities (p<0.004) and fast food consumption (p<0.002) reduced. Conclution: Menstrual symptoms can negatively affect the quality of life and academic success of obese young girls who already have some internal problems. Therefore, authorities should consider research evidence on obesity-related issues when designing education plans for young people and developing relevant guidelines and standardized programs. Özet Amaç: Belirli bir sağlık sorununa odaklanan planlı eğitimler, sağlık davranışlarını teşvik edebilir ve hastalık semptomlarını iyileştirebilir. Bu çalışma, adölesan obez kızların menstrüel semptomlarını iyileştirmek amacıyla Sağlığı Geliştirme Modeli'ne (HPM) göre verilen "Sağlıklı yaşam biçimi davranışları ve menstürasyon (HLB-MENS)" eğitiminin etkisini değerlendirmek amacıyla yapılmıştır. Metod: Bu randomize kontrollü çalışma 1 eylül 2017-21 ocak 2018 tarihleri arasında gerçekleştirilmiştir. Obez grup duyarlı bireylerden oluştuğu için ilk aşamada olasılık dışı rastgele örnekleme yöntemi kullanılmıştır. ikinci aşamada, gönüllülerden rastgele atama yapılmıştır. Araştırmaya liselerde okuyan 9., 10. ve 11. sınıf obez kız çocukları (vücut kitle indeksi > 26,7 kg/m2) dahil edilmiştir. Müdahale (n=63) ve kontrol (n=65) olarak iki grupla çalışılmıştır. Etki büyüklüğü = 0,80 (%80,1 ve p = ,05,)dir. Müdahale grubu 16 haftalık planlı eğitim almış, kontrol grubu katılmamıştır. Eğitim üç farklı başlıktan oluşuyordu. Dersler temel eğitim ve pekiştirme eğitimi olmak üzere iki aşamada gerçekleştirilmiştir. Katılımcılar her bir konuda toplam 7 saat ders aldılar. Bulgular: Sağlıklı yaşam tarzı davranışlarındaki olumlu gelişmeler, obez kızların ruhsal semptomlarını iyileştirdi. Müdahale grubunda MSQ toplam puanları (p<0,007) ve menstrüel ağrı azaldı (p<0,001). HLBS-II toplam puanları (p<0.001) ve fiziksel aktivite alt ölçek puanları (p<0.026.) arttı. Yürüme oranları, fiziksel aktivite davranışları ve fiziksel aktivite süreleri 4 saatin üzerine çıktı, (p<0,001). Günlük aktivitelerden yürüme güçlüğü (p<0,004) ve fast food tüketimi (p<0,002) azaldı. Sonuç: Obez genç kızların adet belirtileri yaşam kalitelerini ve akademik başarılarını olumsuz etkileyebilmektedir. Bu nedenle, yetkililer gençler için eğitim planları tasarlarken ve ilgili yönergeler ve standartlaştırılmış programlar geliştirirken obezite ile ilgili konularda araştırma kanıtlarını dikkate almalıdır. Ayrıca obez genç kızların adet belirtilerini sağlıklı yaşam biçimi davranışlarıyla öğreten HPM modelini benimseyen okullarda ve gençlik merkezlerinde rehberlik hizmetleri açılmalıdır.
... Obesity in women is a risk factor for hormonal abnormalities that result in irregular menstrual cycles and reproductive disorders, such as polycystic ovarian syndrome and infertility. [27] Studies have found significant association between the age of obesity onset and menstrual irregularities. [27] In other words, a substantial proportion of obese adolescents are now suffering from abnormal reproductive development. ...
... [27] Studies have found significant association between the age of obesity onset and menstrual irregularities. [27] In other words, a substantial proportion of obese adolescents are now suffering from abnormal reproductive development. ...
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Precocious puberty, otherwise described as a group of medical conditions that cause early puberty onset, such as a pre-adolescent boy presenting with adult pattern of penile and testicular enlargement or a pre-adolescent girl presenting with mature breast development and onset of menses. Although the sexual and physical characteristics for this condition are well-described in medical literature, the causes are very rarely known. Nevertheless, it has substantial impacts on children’s lives. This is a review on sexual development, premature sexual development, the social complications children suffer from due to early onset puberty, and the associations with daily environmental exposures as possible influences for developing precocious puberty.
... In contrast, in the general population, many women are in positive energy balance and do not exercise sufficiently, which may result in increased BMI. High BMI (30 kg/m2) has been associated with elevated levels of oestrogen, which arise from peripheral aromatisation of androgens in adipose tissue (Seif et al., 2015). Obese women also have higher insulin levels and lower levels of sex hormone-binding globulin (SHBG), than women with normal BMI. ...
... Both stimulate ovarian production of androgens and result in increased levels of free testosterone. All these changes in the normal levels of steroids hormones in obesity are likely to cause disruption of the menstrual cycle and problems such as irregular periods, oligomenorrhoea, amenorrhoea, and HMB (Seif et al., 2015). ...
Article
STUDY QUESTION Are physical activity (PA) and body mass index (BMI) associated with irregular periods and heavy menstrual bleeding (HMB) in Australian women? SUMMARY ANSWER Overweight and obese women have higher odds of both irregular periods and HMB than underweight/normal-weight women, but high levels of PA reduce the odds of HMB. WHAT IS KNOWN ALREADY Most studies on relationships between PA and menstrual problems have focused on female athletes, but there have been few population-based studies. STUDY DESIGN, SIZE, DURATION Prospective cohort study, 10618 participants in the Australian Longitudinal Study of Women’s Health (ALSWH) who completed mailed surveys in 1996, with follow-ups in 2000, 2003, 2006, 2009, 2012, and 2015. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were aged 22 to 27 in 2000. They were asked to report their PA levels and the frequency of irregular periods and HMB in each survey. BMI was calculated at every survey from self-reported weight and height. Generalised estimating equation population-averaged model analyses were conducted to calculate odds ratios (OR) and 95% confidence intervals (95% CIs). MAIN RESULTS AND THE ROLE OF CHANCE At age 22 to 27 years, the prevalence of irregular periods was 19.4%. This remained stable over 15 years. There were no associations between PA and irregular periods. Overweight and obese women had higher odds of irregular periods [overweight: OR 1.08, (95% CI 1.00–1.17); obese: OR 1.29, (95%CI 1.18–1.41)] than women who were underweight/normal weight. The prevalence of HMB at age 22–27 years was 15.9%; this doubled over 15 years. Women who were highly active had 10% lower odds of HMB than women who reported no PA [OR 0.90, (95%CI 0.82–0.98)]. Overweight and obese women had higher odds of HMB [overweight: OR 1.15, (95%CI 1.07–1.23); obese: OR 1.37, (95%CI 1.26–1.49)] than women who were underweight/normal weight. Among obese women, high levels of PA were associated with 19% [OR 0.81, (95%CI 0.68–0.97)] reduction in the odds of HMB. LIMITATIONS, REASONS FOR CAUTION Data collected in the ALSWH are self-reported, which may be subject to recall bias. Reverse causation, due to menstrual problems impacting PA, is possible although sensitivity analyses suggest this is unlikely to have affected the results. Other conditions, e.g., polycystic ovary syndrome, for which no or incomplete data were available, could have affected the results. WIDER IMPLICATIONS OF THE FINDINGS Intervention studies are needed to assess the effect of increasing PA in women with HMB, but these preliminary findings suggest that promoting PA could be an affordable and feasible strategy for reducing HMB in young adult women. STUDY FUNDING/COMPETING INTEREST(S) The ALSWH is funded by the Australian Government. Funding for these analyses was provided by a University of Queensland (UQ) International Postgraduate Research Scholarship and a UQ International Development Fellowship. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A
... In obese but normally cycling females, the variable effect of leptin on SNA during the reproductive cycle may contribute to the poor correlation of SNA to indices of obesity. Moreover, obesity can disrupt reproductive cycling in women [71] and rats [72,73], with variable effects on estrogen levels, which may also explain in part this lack of correlation in females, unlike males. Finally, even if the obese state increases estrogen as it increases leptin, leptin may still not drive elevated SNA, because obesity in females engenders resistance to its sympathoexcitatory effects (unlike males), as it does to insulin (see below). ...
... In parallel, we have found that ArcN AngII nanoinjections produce the greatest increases in SNA during estrus; ArcN AngII is ineffective during proestrus (Shi and Brooks, unpublished findings). Interestingly, while obesity has been associated with reproductive cycle disruption [72,73] and increases or decreases in estrogen [71], a common feature is a decrease in progesterone [129]. Thus, a hypothesis to be tested is that obesity-induced falls in progesterone, especially if associated with increases in estrogen, decreases ArcN AT1R expression, and its ability to suppress NPY sympathoinhibition. ...
Article
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Obesity increases sympathetic nerve activity (SNA) in men, but not women. Here, we review current evidence suggesting that sexually dimorphic sympathoexcitatory responses to leptin and insulin may contribute. More specifically, while insulin increases SNA similarly in lean males and females, this response is markedly amplified in obese males, but is abolished in obese females. In lean female rats, leptin increases a subset of sympathetic nerves only during the high estrogen proestrus reproductive phase; thus, in obese females, because reproductive cycling can become impaired, the sporadic nature of leptin-induced sympathoexcitaton could minimize its action, despite elevated leptin levels. In contrast, in males, obesity preserves or enhances the central sympathoexcitatory response to leptin, and current evidence favors leptin's contribution to the well-established increases in SNA induced by obesity in men. Leptin and insulin increase SNA via receptor binding in the hypothalamic arcuate nucleus and a neuropathway that includes arcuate neuropeptide Y (NPY) and proopiomelanocortin (POMC) projections to the paraventricular nucleus. These metabolic hormones normally suppress sympathoinhibitory NPY neurons and activate sympathoexcitatory POMC neurons. However, obesity appears to alter the ongoing activity and responsiveness of arcuate NPY and POMC neurons in a sexually dimorphic way, such that SNA increases in males but not females. We propose hypotheses to explain these sex differences and suggest areas of future research.
... Issues of obesity and its related health problems have generated an increased attention to the perception of and satisfaction with body image and shape. Body image distortion can lead to inappropriate diet restriction, eating disorders, and excessive weight loss, which in turn, give rise to reproductive function issues, such as menstrual irregularity, hypothalamic dysfunction, infertility, and bone loss due to impaired sex hormone metabolism (5)(6)(7)(8)(9). Moreover, body dissatisfaction is linked to adverse psychological consequences such as poor selfesteem, depression, and anxiety (10)(11)(12). ...
Article
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Background Misperception of body weight is associated with various psychological and health problems, including obesity, eating disorders, and mental problems. To date, female-specific risk factors, including socioeconomic or health-related lifestyle features, or their indicative performance for the misperception in Asian women according to age groups remain unknown. Objectives To investigate the prevalence and associated risk factors for the mismatch in self-perceived body weight and evaluated the classification performance of the identified risk factors across age groups in female adults. Methods We analyzed data of 22,121 women (age 19–97 years) from the 7-year Korea National Health and Nutrition Examination Survey dataset (2010-2016). We evaluated self-perceived body weight of the participants with their actual weight using the body mass index cut-off and grouped them by age: early adulthood (19–45), middle adulthood (46–59), and late adulthood (≥60). Logistic regression was conducted in each age group based on their weight misperception. The classification performance of the identified risk factors was evaluated with a bagging tree ensemble model with 5-fold cross-validation. Results 22.2% (n=4,916) of the study participants incorrectly perceived their body weight, of which 14.1% (n=3,110) and 8.2% (n=1,806) were in the underestimated and overestimated groups. Among the age groups, the proportion of participants who misperceived their body weight was highest in late adulthood (31.8%) and the rate of overestimation was highest in early adulthood (14.1%). We found that a lower education level, absence of menopause, perception of themselves as unhealthy, and efforts for weight management were significantly associated with the overall misperception (overestimation or underestimation) of body weight across age groups. Based on the identified risk factors, the highest area under the receiver operating curve (AUROC) and accuracy of the best classification model (weight overestimation in all participants) were 0.758 and 0.761, respectively. Adding various associated lifestyle factors to the baseline model resulted in an average increase of 0.159 and 0.135 in AUROC for classifying weight underestimation and overestimation, respectively. Conclusions Age, education level, marital status, absence of menopause, amount of exercise, efforts for weight management (gain, loss, and maintenance), and self-perceived health status were significantly associated with the mismatch of body weight.
... Доказано, что ожире-ние является фактором риска сердечно-сосудистых и онкологических заболеваний (молочной железы, яичника, эндометрия, толстого кишечника), а также бесплодия [5]. Для пациенток с ожирением характерна аменорея, олигоменорея и нерегулярные менструации [6]. Основной причиной бесплодия у тучных женщин, по мнению многих авторов, является хроническая ановуляция [4,7]. ...
Article
Aim. To assess the hormonal profile features in obese reproductive-age women. Materials and Methods. We consecutively enrolled 163 women of reproductive age (140 women with body mass index ≥ 30 kg/m ² and 23 women with normal body mass index) who have been admitted to Podgorbunskiy Regional Emergency Medicine Hospital. All patients of both groups underwent general and gynecological examination. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, estradiol, estrone, testosterone, dehydroepiandrosterone sulfate, thyroid-stimulating hormone, free triiodothyronine, total and free thyroxine, cortisol, leptin, immunoreactive insulin, and progesterone were assessed on days 5-6 and 21-22 of the menstrual cycle. Results. Obese women of reproductive age were characterised by higher values of LH, LH/ FSH ratio, testosterone, estradiol, estrone, leptin, IRI and by lower levels of FSH and progesterone compared with normal weight women. A direct correlation was found between the level of leptin and estrone (r = 0.21, p = 0.014), insulin resistance (r = 0.18, p = 0.039), triglycerides (r = 0.20, p = 0.030), and low-density lipoprotein cholesterol (r = 0.22, p = 0.016). There was a statistically significant inverse correlation between the level of leptin and high-density lipoprotein cholesterol (r = -0.18, p = 0.043). A direct correlation was established between insulin and LH (r = 0.24, p = 0.030), testosterone (r = 0.32, p = 0.037), dehydroepiandrosterone sulfate (r = 0.56, p = 0.003), insulin resistance (r = 0.95, p < 0.001), cholesterol (r = 0.20, p = 0.024), triglycerides (r = 0.29, p < 0.001). Conclusion. Obese women of reproductive age have certain hormonal features that underlie menstrual and reproductive disorders in these patients.
... Additionally, smoking status can influence menstrual cycle irregularity, thus it would be an important element to capture [4]. Similarly with BMI, at either end of the spectrum, there are known associations with menstrual irregularities, thus a possible contributing factor to menstrual cycle symptoms and changes in characteristics [81,82], especially given the possible fluctuations in eating behaviours and weight throughout the pandemic [36]. Finally, our data only provides a small insight into the changes experienced by females during the initial onset of COVID-19 pandemic and subsequent lockdown; it does not provide any longitudinal data that may document the rise and fall of symptom exacerbation or the degree of severity that the females may have been affected by such environmental changes. ...
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This research investigated the implications that the COVID-19 pandemic had on the menstrual cycle and any contributing factors to these changes. A questionnaire was completed by 559 eumenorrheic participants, capturing detail on menstrual cycle symptoms and characteristics prior to and during the COVID-19 pandemic lockdown period. Over half of all participants reported to have experienced lack of motivation (61.5%), focus (54.7%) and concentration (57.8%). 52.8% of participants reported an increase in cycle length. Specifically, there was an increase in the median cycle length reported of 5 days (minimum 2 days, maximum 32 days), with a median decrease of 3 days (minimum 2 days and maximum 17 days). A lack of focus was significantly associated with a change in menstrual cycle length (p = 0.038) reported to have increased by 61% of participants. Changes to eating patterns of white meat (increase p = 0.035, decrease p = 0.003) and processed meat (increase p = 0.002 and decrease p = 0.001) were significantly associated with a change in menstrual cycle length. It is important that females and practitioners become aware of implications of environmental stressors and the possible long-term effects on fertility. Future research should continue to investigate any long-lasting changes in symptoms, as well as providing education and support for females undergoing any life stressors that may implicate their menstrual cycle and/or symptoms.
... Extremes of body weight have been linked with adverse health conditions (including cardiometabolic and psychological) to the extent that weight management is usually considered in the prevention and/or treatment of these conditions. Literatures have associated extremes in body weight with certain medical conditions including type-2 diabetes mellitus, hypertension, tumors, fatty liver disease, musculoskeletal disorders, menstrual disorders and cardiovascular diseases resulting in low quality of life [1][2][3][4][5][6][7] . A greater number of students in the tertiary institutions of learning are within the youthful age group, 15-24 years [8] . ...
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Background of the study: Weight control is increasingly becoming one of the most discussed topics amongst the youths due to adverse social and medical conditions associated with extremes body weight. Aim: The aim of the present study was to assess the gender variations in weight control behaviors amongst undergraduates in Port Harcourt, Rivers state, South-South, Nigeria. Materials and methods: The study involved 600 apparently healthy students (including 249 males and 351 females) who responded to an interviewer-administered questionnaire. Results: The results showed that the weight control strategies applied by undergraduates are typically aimed at either maintaining or reducing their present body weight. More of the males are satisfied with their weight and would engage in regular exercise to maintain it. Females had a high tendency to be dissatisfied with their body weight and shape and would associate their overweight with overfeeding. Although exercise was the most common weight control measure adopted by both male and female respondents, only 20.5% of them engaged in regular exercise. 51.4% of subjects did not consider applying any weight control measure necessary. Dietary restriction was more commonly adopted by females. The most commonly skipped meal by both male and female undergraduates was lunch. However, more females skipped dinner in other to lose weight. Conclusion: The present study suggests that body weight perception is a very important determinant of weight control behavior. Social acceptance is a common phenomenon amongst female undergraduates who are also more concerned about their body weight and shape.
... The occurrence of bleeding irregularities depends on the type of oral contraceptive (OC) [4] but may also result from a lack of treatment adherence, interactions with other drugs or intercurrent illness, such as vomiting and diarrhea. Moreover, smoking and a high body mass index (BMI) increase the likelihood of bleeding irregularities [5,6]. ...
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Bleeding irregularities are one of the major reasons for discontinuation of oral contraceptives (OCs), and therefore clinicians need to set expectations during consultations. In this review we provide an overview of bleeding data of recently marketed cyclic combined OCs (COCs) and one progestin-only pill (POP). We evaluated data from phase 3 trials (≥12 months) used to gain regulatory approval. Overall, each type of OC has its own specific bleeding pattern. These patterns however were assessed by using different bleeding definitions, which hampers comparisons between products. In COCs, the estrogen balances the effects of the progestin on the endometrium, resulting in a regular bleeding pattern. However, this balance seems lost if a too low dose of ethinylestradiol (EE) (e.g., 10 µg in EE/norethindrone acetate 1 mg) is used in an attempt to lower the risk of venous thromboembolism. Replacement of EE by 17β-estradiol (E2) or E2 valerate could lead to suboptimal bleeding profile due to destabilization of the endometrium. Replacement of EE with estetrol (E4) 15 mg in the combination with drospirenone (DRSP) 3 mg is associated with a predictable and regular scheduled bleeding profile, while the POP containing DRSP 4 mg in a 24/4 regimen is associated with a higher rate of unscheduled and absence of scheduled bleeding than combined products.
... Although obesity has been previously associated with HMB risk (Seif et al., 2015), the present data cannot confirm this putative relationship because antipsychotic medication use itself was associated with increasing BMI in women with SCZ. Additionally, we did not assess HMB prior to mental illness onset. ...
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There has been limited studies examining treatment-induced heavy menstrual bleeding (HMB) in women with severe mental illnesses. The aim of this study was to examine HMB prevalence and HMB-associated factors in young women (18–34 years old) diagnosed with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia (SCZ) who have full insight and normal intelligence. Eighteen-month menstruation histories were recorded with pictorial blood loss assessment chart assessments of HMB. Multivariate analyses were conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Drug effects on cognition were assessed with the MATRICS Consensus Cognitive Battery (MCCB). HMB prevalence were: BP, 25.85%; MDD, 18.78%; and SCH, 13.7%. High glycosylated hemoglobin (HbA1c) level was a strong risk factor for HMB [BP OR, 19.39 (16.60–23.01); MDD OR, 2.69 (4.59–13.78); and SCZ OR, 9.59 (6.14–12.43)]. Additional risk factors included fasting blood sugar, 2-h postprandial blood glucose, and use of the medication valproate [BP: OR, 16.00 (95%CI 12.74–20.22); MDD: OR, 13.88 (95%CI 11.24–17.03); and SCZ OR, 11.35 (95%CI 8.84–19.20)]. Antipsychotic, antidepressant, and electroconvulsive therapy use were minor risk factors. Pharmacotherapy-induced visual learning impairment was associated with HMB [BP: OR, 9.01 (95%CI 3.15–13.44); MDD: OR, 5.99 (95%CI 3.11–9.00); and SCZ: OR, 7.09 (95%CI 2.99–9.20)]. Lithium emerged as a protective factor against HMB [BP: OR, 0.22 (95%CI 0.14–0.40); MDD: OR, 0.30 (95%CI 0.20–0.62); and SCZ: OR, 0.65 (95%CI 0.33–0.90)]. In SCZ patients, hyperlipidemia and high total cholesterol were HMB-associated factors (ORs, 1.87–2.22). Psychiatrist awareness of HMB risk is concerningly low (12/257, 2.28%). In conclusion, prescription of VPA should be cautioned for women with mental illness, especially BP, and lithium may be protective against HMB.
... Obesity interferes with ultrasound assessment, making it difficult to obtain clear visualization of underlying organs. The patient's history of irregular menstrual cycles and bleeding may have been assumed to be secondary to obesity and hormonal imbalance [14,15]. Unexplained history of bleeding abnormalities and abdominal pain should raise suspicion for an ovarian tumor. ...
Article
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Introduction and importance: Adult granulosa cell tumor (GCT) is a rare stromal cell neoplasm that most often arises from the ovary. Presenting symptoms are related to external compression of adjacent structures (mass effect) or secretion of hormones such as estrogen. Patients most commonly present with irregular menstruation, postmenopausal bleeding, and abdominal pain. Prolonged estrogen exposure can contribute to endometrial adenocarcinoma development in untreated patients. The highly vascular nature of GCTs can lead to hemorrhagic rupture in rare cases. Presentation of case: We describe a case of adult GCT in a 44-year-old female with a history of irregular menstrual bleeding and anemia. The patient presented with shortness of breath and abdominal pain. Computed tomography (CT) scan demonstrated possible hemorrhagic ascites of unclear etiology and a pelvic mass. The patient was brought to the operating room in hemorrhagic shock for surgical exploration where she was found to have active bleeding of a ruptured ovarian tumor for which she underwent left salpingo-oophorectomy. Postoperative course was unremarkable, and pathology demonstrated ruptured GCT. Clinical discussion: Although rare, ovarian tumors can present with massive bleeding following rupture. Granulosa cell tumors are surreptitious as they grow slowly, and symptoms such as distention, abdominal pain, and irregular vaginal bleeding are nonspecific. Conclusion: CT findings demonstrating a pelvic mass in the setting of spontaneous intra-abdominal bleeding should raise clinical suspicion, particularly in patients with histories of menstrual abnormalities. Patients with suspected intra-abdominal hemorrhage due to any cause are best treated by prompt surgical exploration and aggressive resuscitation.
... As some of the study cohorts used LNG-IUS in addition to HRT, it could very likely have influenced the results. Moreover, LNG-IUS is therapeutically used against abnormal bleeding and menorrhagia, which is more common in obese women [19] who are also at higher risk for BC [20]. Another confounder could have been a selection bias because LNG-IUS is more often prescribed to women with a family history of BC [12]. ...
Article
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Purpose The intention of this systematic review was to analyze the literature on breast cancer (BC) and the use of the levonorgestrel-releasing intrauterine system (LNG-IUS). Methods The literature was searched in Medline, Embase, Cochrane Library, CINAHL, Web of Science and ClinicalTrials.com and included search terms related to breast cancer and LNG-IUS. After elimination of duplicates, 326 studies could be identified and were assessed according to inclusion and exclusion criteria. In the end, 10 studies met the defined criteria and were included in the systematic review. Results 6 out of the 10 selected studies were cohort studies, three were case–control studies and one a systematic review/meta-analysis. 6 found a positive association between BC and the use of LNG-IUS. One study only found an increased risk for invasive BC in the subgroup of women aged 40–45 years. In contrast, three studies showed no indication of a higher BC risk. Conclusion The results imply an increased BC risk in LNG-IUS users, especially in postmenopausal women and with longer duration of use. Positive effects of the LNG-IUS such as reduced risks for other hormonal cancers have been observed, were, however, not focus of this systematic review. The heterogeneity of the analyzed studies and vast number of confounding factors call for further investigations in this issue. Patients should be advised according to their individual risk profile and hormone-free alternatives may be considered for women with a history of BC.
... На особливу увагу заслуговує порушення менструального циклу (МЦ) на тлі ожиріння. Згідно з даними низки досліджень визначено, що жировий кластер є одним із підтипів тканини сполучного типу [3,4]. Ця структура не тільки має депонувальну функцію, але й відповідає за синтез адипокінів, що впливають на гомеостаз, метаболізм та функціонування гіпоталамо-гіпофізарної системи [5,6]. ...
Article
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The objective: a study the features of the course and onset of menstrual function in patients with morbid obesity (MO). Materials and methods. A survey of 97 patients of reproductive age with MO, who were included in the main group, and 60 healthy women, who were included in the control group, was performed. All women were comparable in age. The average age of the examined patients was 34.7±2.6 years. The body mass index of women in the main group was 38.8±4.2 kg/m2, the control group – 22.6±2.8 kg/m2.All patients gave informed consent to the processing of personal data. The obtained digital data were processed using licensed statistical programs Microsoft Office 2007 and Stata 12 by variational statistics methods. Results. The early menarche was observed in 35 (36.08%) patients of the main group versus 4 (6.67%) of the control group (p<0.05), late menarche – 38 (39.17%) and 7 (11.67%) women, respectively (p<0.05), menstrual dysfunction – 65 (67.0%) and 12 (20.0%; p<0.05), oligomenorrhea – 54 (56.67%) and 5 (8.33%; p<0.05), respectively, and hypermenorrhea – 38.14% of women in the main group. Often, patients with MO had menstrual irregularities in the form of shortened and heavy menstruations. In women with MO polycystic ovary syndrome – 21 (18.55%) patients, abnormal uterine bleeding – 37 (38.14%), endometrial hyperplasia – 18 (19.14%), uterine leiomyoma – 27 (27.83%), endometriosis – 22 (22.68%), infertility – 28 (28.86%) and benign breast diseases – 36 (37.11%) persons were diagnosed significantly more often compared to the healthy womenConclusions. In women with morbid obesity, a high frequency of disorders of the ovarian menstrual function was found, which may indicate the existence of a close relationship between the presence of obesity and the development of hormonal changes in the female reproductive system.
... Major socio-emotional, biological and psychological changes that occur during puberty have the potential to alter developmental trajectories in the early years of adolescence [6,7]. Previous research has explored several risk factors for menstrual irregularities, including age at menarche, moderate or vigorous exercise [8,9] and obesity [10,11]. In addition to the physical factors, work-related and psychosocial stress and mental illnesses were also reported as risk factors for menstrual disorders [12][13][14][15][16]. Epidemiological studies have shown that rates of depression are approximately equal between boys and girls before the onset of puberty, after which, rates for depression in girls are approximately twice that of boys [17,18]. ...
Article
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Background The study examined the prevalence of self-reported menstrual irregularities during adolescence and explored the association of depressive symptoms with self-reported menstrual irregularities in adolescents in two major states of Uttar Pradesh and Bihar in India. Methods This study is based on the data obtained from the first round of the "Understanding the lives of adolescents and young adults" (UDAYA, 2016) survey. The effective sample size for the study was 12,707 adolescent girls aged 10–19 years. A bivariate analysis with chi-square test was conducted to determine the self-reported menstrual irregularity by predictor variables. Multivariable logistic regression models were employed to examine the associations between self-reported menstrual irregularity, depressive symptoms and other explanatory variables. Results A proportion of 11.22% of adolescent girls reported menstrual irregularity and 11.40% of the participants had mild depressive symptoms. Adolescent girls with mild (AOR: 2.15, CI: 1.85–2.51), moderate (AOR: 2.64, CI: 2.03–3.42) and severe depressive symptoms (AOR: 2.99, CI: 2.19–4.10) were more likely to have menstrual irregularity as compared to those who had minimal depressive symptoms. Physically active adolescent girls were less likely to report menstrual irregularity (AOR: 0.82, CI: 0.73–0.93) than physically inactive girls. Adolescent girls who used piece of cloth for menstrual hygiene practices (AOR: 1.17; CI: 1.02–1.35) and those who used either napkin or cloth or other materials (AOR: 1.32; CI: 1.14–1.54) had higher likelihood of menstrual irregularity as compared to those who used only sanitary napkins. Conclusion A significant association of depressive symptoms with self-reported menstrual irregularity among adolescent girls was observed. Therefore, while treating females with irregular menstrual cycles, clinicians may need to pay greater attention to thir mental health peoblems.
... These hormonal changes can result in ovulatory dysfunction (AUB-O), which is infrequent ovulation that extends the proliferative phase of the menstrual cycle 182 . This increased exposure to unopposed oestrogen could support excess proliferation within the endometrium and increase the likelihood of menstrual disturbances 183 . ...
Article
Menstruation is a physiological process that is typically uncomplicated. However, up to one third of women globally will be affected by abnormal uterine bleeding (AUB) at some point in their reproductive years. Menstruation (that is, endometrial shedding) is a fine balance between proliferation, decidualization, inflammation, hypoxia, apoptosis, haemostasis, vasoconstriction and, finally, repair and regeneration. An imbalance in any one of these processes can lead to the abnormal endometrial phenotype of AUB. Poor menstrual health has a negative impact on a person's physical, mental, social, emotional and financial well-being. On a global scale, iron deficiency and iron deficiency anaemia are closely linked with AUB, and are often under-reported and under-recognized. The International Federation of Gynecology and Obstetrics have produced standardized terminology and a classification system for the causes of AUB. This standardization will facilitate future research endeavours, diagnosis and clinical management. In a field where no new medications have been developed for over 20 years, emerging technologies are paving the way for a deeper understanding of the biology of the endometrium in health and disease, as well as opening up novel diagnostic and management avenues.
... It is also appreciated that metabolic and reproductive pathways are interconnected and involve reciprocal feedback control mechanisms [66][67][68]. During periods of starvation, anorexia or excessive weight gain, reproduction is down-regulated and ovulation becomes irregular or ceases [69,70]. Similarly, metabolic function is coordinated with the menstrual cycle to ensure optimal physiological conditions for fertilization, implantation, pregnancy, parturition and lactation [71]. ...
Article
Full-text available
Polycystic ovary syndrome (PCOS) is increasingly recognized as a complex metabolic disorder that manifests in genetically susceptible women following a range of negative exposures to nutritional and environmental factors related to contemporary lifestyle. The hypothesis that PCOS phenotypes are derived from a mismatch between ancient genetic survival mechanisms and modern lifestyle practices is supported by a diversity of research findings. The proposed evolutionary model of the pathogenesis of PCOS incorporates evidence related to evolutionary theory, genetic studies, in utero developmental epigenetic programming, transgenerational inheritance, metabolic features including insulin resistance, obesity and the apparent paradox of lean phenotypes, reproductive effects and subfertility, the impact of the microbiome and dysbiosis, endocrine-disrupting chemical exposure, and the influence of lifestyle factors such as poor-quality diet and physical inactivity. Based on these premises, the diverse lines of research are synthesized into a composite evolutionary model of the pathogenesis of PCOS. It is hoped that this model will assist clinicians and patients to understand the importance of lifestyle interventions in the prevention and management of PCOS and provide a conceptual framework for future research. It is appreciated that this theory represents a synthesis of the current evidence and that it is expected to evolve and change over time.
... Переважним типом порушення менструальної функції є олігоменорея (у 60 %), аменорея відзначається в 29 % випадків [6]. А при настанні вагітності в пацієнток можуть спостерігатися цукровий діабет, прееклампсія, затримка внутрішньоутробного розвитку плода, передчасне відшарування нормально розташованої плаценти, висока ймовірність кесарева розтину, мертвонародження, підвищена материнська смертність [7,8]. У жінок з ожирінням частіше спостерігаються такі ускладнення пологів, як слабкість пологової діяльності, передчасний чи запізнілий вилив навколоплідних вод [6]. ...
Article
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Obesity remains a serious health problem in all count­ries due to its prevalence and the development of significant health consequences associated with high morbidity and mortality. According to the World Health Organization, over 1.5 billion adults in the modern world are overweight. According to domestic studies, about 40 % of the population of Ukraine is overweight and 25 % is obese. The literature review focuses on the problem of obesity in the peri- and postmenopausal periods. Because adipose tissue is the site of conversion of bioactive estrogens from androgenic precursors, it could be assumed that obese women should be less likely to deve­lop symptoms of menopausal disorders such as vascular disorders, osteo­porosis. Obesity affects ovulation, oocyte maturation, proces­ses in the endometrium, and the process of implantation. Obesity impairs reproductive function not only through the mechanisms of ovulation disorders: reduced fertility is observed in patients with re­gular ovulatory cycles. Other mechanisms (the complex influence of psychosocial factors; the level of proinflammatory cytokines secre­ted by adipose tissue is increased in obesity) have not only a direct embryotoxic effect, but also limit the invasion of the trophoblast, disrupting its normal formation. Excessive amounts of pro-inflammatory cytokines lead to local activation of prothrombinase and as a result to thrombosis, trophoblast infarction, its detachment and, ultimately, early miscarriage. The relationship between obesity and reproductive dysfunction has long been proven. At the same time, weight loss is known to improve this function in overweight and obese women. It is especially important that women with this pathology, who visit specialist physicians, receive the necessary re­commendations and support aimed at weight loss.
... It is also appreciated that metabolic and reproductive pathways are interconnected and involve reciprocal feedback control mechanisms (66)(67)(68). During periods of starvation, anorexia or excessive weight gain, reproduction is down-regulated and ovulation becomes irregular or ceases (69,70). Similarly, metabolic function is co-ordinated with the menstrual cycle to ensure optimal physiological conditions for fertilisation, implantation, pregnancy, parturition and lactation (71). ...
Preprint
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Polycystic ovary syndrome (PCOS) is increasingly recognized as a complex metabolic disorder that manifests in genetically susceptible women following a range of negative exposures to nutritional and environmental factors related to contemporary lifestyle. The hypothesis that PCOS phenotypes are derived from a mismatch between ancient genetic survival mechanisms and modern lifestyle practices is supported by a diversity of research findings. The proposed evolutionary model of the pathogenesis of PCOS incorporates evidence related to evolutionary theory, genetic studies, in-utero developmental epigenetic programming, transgenerational inheritance, metabolic features including insulin resistance, obesity and the apparent paradox of lean phenotypes, reproductive effects and subfertility, the impact of the microbiome and dysbiosis, endocrine disrupting chemical exposure, and the influence of lifestyle factors such as poor quality diet and physical inactivity. Based on these premises, the diverse lines of research are synthesized into a composite evolutionary model of the pathogenesis of PCOS. It is hoped that this model will assist clinicians and patients to understand the importance of lifestyle interventions in the prevention and management of PCOS and provide a conceptual framework for future research. It is appreciated that this theory represents a synthesis of the current evidence and that it is expected to evolve and change over time.
... However, we also recognize that FSH levels may fluctuate and that the cross-sectional nature of this study does not capture variations over time. In addition, we cannot exclude secondary amenorrhoea in these four women; obesity itself can result in changes in levels of gonadal steroid hormones, resulting in anovulatory cycles and irregular or absent menses [19]. We did not find a correlation between serum FSH and severity of menopausal symptoms (and specifically severity of hot flushes). ...
Article
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Objectives We examined follicle-stimulating hormone (FSH) levels in women living with HIV aged > 45 reporting ≥ 12 months’ amenorrhoea, and investigated correlation with menopausal symptoms. Methods A cross-sectional substudy of 85 women from the Positive Transitions through the Menopause (PRIME) Study who reported irregular periods at entry into the PRIME Study and ≥ 12 months’ amenorrhoea at recruitment into this substudy. Serum FSH was supplemented with clinical data and menopausal symptom assessment. Serum FSH > 30 mIU/mL was defined as consistent with postmenopausal status. Associations between FSH and menopausal symptom severity were assessed using Pearson's correlation and the Kruskal–Wallis test. Results Median age was 53 years [interquartile range (IQR): 51–55]; all were on antiretroviral therapy, three-quarters (n = 65) had a CD4 T-cell count > 500 cells/μL and 91.8% (n = 78) had an HIV viral load (VL) < 50 copies/mL. Median FSH was 65.9 mIU/mL (IQR: 49.1–78.6). Only four women (4.7%) had FSH ≤ 30 mIU/mL; none reported smoking or drug use, all had CD4 T-cell count ≥ 200 cells/μL, and one had viral load (VL) ≥ 50 copies/mL. Median body mass index (BMI) was elevated compared with women with FSH > 30 mIU/mL (40.8 vs. 30.5 kg/m²). Over a quarter (28.2%) reported severe menopausal symptoms, with no correlation between FSH and severity of menopausal symptoms (p = 0.21), or hot flushes (p = 0.37). Conclusions Four women in this small substudy had low FSH despite being amenorrhoeic; all had BMI ≥ 35 kg/m². We found that 95% of women with HIV aged > 45 years reporting ≥ 12 months’ amenorrhoea had elevated FSH, suggesting that menopausal status can be ascertained from menstrual history alone in this group.
... About 1 mg of iron is lost each day through desquamation of cells from skin and mucosal cells, including the lining of the gastrointestinal tract [10]. In premenopausal adult women, menstruation increases the average daily iron loss to about 2 mg per day, but this loss can be much greater in the case of heavy menstrual bleeding, which is common in obese women [11,12]. Since there is no physiological mechanism of iron excretion, only intestinal absorption adjusts the stores of body iron [13]. ...
Article
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Iron deficiency with or without anemia, needing continuous iron supplementation, is very common in obese patients, particularly those requiring bariatric surgery. The aim of this study was to address the impact of weight loss on the rescue of iron balance in patients who underwent sleeve gastrectomy (SG), a procedure that preserves the duodenum, the main site of iron absorption. The cohort included 88 obese women; sampling of blood and duodenal biopsies of 35 patients were performed before and one year after SG. An analysis of the 35 patients consisted in evaluating iron homeostasis including hepcidin, markers of erythroid iron deficiency (soluble transferrin receptor (sTfR) and erythrocyte protoporphyrin (PPIX)), expression of duodenal iron transporters (DMT1 and ferroportin) and inflammatory markers. After surgery, sTfR and PPIX were decreased. Serum hepcidin levels were increased despite the significant reduction in inflammation. DMT1 abundance was negatively correlated with higher level of serum hepcidin. Ferroportin abundance was not modified. This study shed a new light in effective iron recovery pathways after SG involving suppression of inflammation, improvement of iron absorption, iron supply and efficiency of erythropoiesis, and finally beneficial control of iron homeostasis by hepcidin. Thus, recommendations for iron supplementation of patients after SG should take into account these new parameters of iron status assessment.
... Bu değişiklikler ovülasyonun bozulmasına ve oligomenore, düzensiz adet kanaması, amenore ve bazen hipermenore gibi menstrüel bozukluklara neden olmaktadır. Hastalar, kilo kaybı ile birlikte hem periferik yağ doku azalacağından androjenlerin östrojenlere aromatizasyonu azaltarak, hem de SHBG, insülin, testosteron ve diğer hormonal değişikliklerin normalleştirilmesiyle aşırı menstrüel kanamaların azalabileceği ve düzenli menstrüel siklusların elde edilebileceği konusunda bilgilendirilmelidir. Menstrüel düzensizlikler bazı obez adolesanlarda daha stresli olabileceğinden, günlük yaşamı nasıl bozduğunu araştırmak ve değerlendirmek, sağlıklı beslenme ve fiziksel egzersiz ile kilo vermeyi tavsiye etmek her zaman önemlidir (16). Amenorenin tedavisinde düşük doz östrojen (etinil östradiol 1 veya 2 µg/gün veya konjuge östrojen 0,3 mg/gün) ile başlanır, östrojen dozu zaman içinde giderek arttırılır ve belli bir doza ulaşıldığında veya kırılma kanaması görüldüğünde tedaviye progesteron (progestin 5-10 mg/gün siklusun 16-25. ...
... 3 Seif et al in 2015 reported that the prevalence of menstrual cycle irregularities was 8.4% in women who were 74% overweight, as compared to 2.6% in women who were <20% overweight. 5 A further study documented that being 15% overweight was associated with a significantly higher chance of having a menstrual cycle longer than 43 days. ...
Article
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Background: As the rate of obesity is increasing in women in the recent years, the incidence of endometrial cancer increases as the body mass index (BMI) increases. Despite the clear evidence linking endometrial cancer and obesity, there is limited public awareness of this relationship. This study was undertaken to evaluate the association of BMI and endometrial pathology in premenopausal women with abnormal uterine bleeding (AUB).Methods: An analytical case control study was conducted in 100 women between the age group of 40 to 55, with AUB in the Department of Obstetrics and Gynecology, ESIC-PGIMSR Bangalore between January 2018 and June 2019. The menstrual patterns and endometrial pattern by histopathology were analysed in women with BMI of 18.5 to 24.99 and ≥25.Results: The mean age of women participated in the study group of between 40- 55 years was 44.83. The mean duration of symptoms was 10.18 months in the cases group and 8.52 months in the control group. The menstrual patterns were comparable and there was no significant difference in both the groups. The mean endometrial thickness, mean BMI, hyperplasia with or without atypia were all higher in the cases group. The frequency of occurrence of atypical endometrial hyperplasia was higher in women with increasing BMI.Conclusions: We found increased BMI to be an important independent risk factor for the development of endometrial hyperplasia with atypia which is a precursor to endometrial carcinoma in premenopausal women with AUB.
... Interestingly, there are evidences indicating that obesity is associated with menstrual disorders which affect the level of female sex steroids. 54 Considering the level of reproductive hormones impacts autonomic regulation and cardiovascular homeostasis, inconsistent sex hormones in obesity may affect resting MSNA in young women. Unfortunately, it remains unknown whether obesity related menstrual disorders affects sympathetic activation F I G U R E 1 Correlations between resting muscle sympathetic nerve activity (MSNA) and body mass index (BMI) in young men and young women. ...
Article
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In this brief review, we summarize the current knowledge on the complex interplay between metabolism, sympathetic activity and hypertension with a focus on sex differences and changes with age in humans. Evidence suggests that in premenopausal women, sex hormones, particularly estrogen exerts a profound cardioprotective effect which may be associated with favorable metabolic profiles, as well as lower sympathetic activity and blood pressure at rest and any given physiological and environmental stimuli compared with men of a similar age. Along this line, premenopausal women seem to be generally protected from obesity‐induced metabolic and cardiovascular complications. However, postmenopausal estrogen deprivation during midlife and older age has a detrimental impact on metabolism, may lead to adipose tissue redistribution from the subcutaneous to abdominal area, and augments sympathetic activity. All these changes could contribute significantly to the higher prevalence of hypertension and greater cardiometabolic risk in older women than older men. It is proposed that obesity‐related hypertension has a neurogenic component which is characterized by sympathetic overactivity, but the impact of sex and age remains largely unknown. Understanding sex and age‐specific differences in obesity and sympathetic neural control of blood pressure is important in the prevention and/or risk reduction of cardiometabolic disorders for both men and women.
... Obesity and PCOS appear to have a bidirectional interaction, each significantly exacerbating the other condition. [26][27][28] Few studies have explored the contribution of weight gain, overweight and obesity to menstrual disturbance and PCOS in this cohort. Therefore, we sought to evaluate the relationships between BMI on menstrual irregularity and PCOS, respectively, in young women with T1D. ...
Article
Background Type 1 diabetes (T1D) is associated with reproductive dysfunction, particularly in the setting of poor metabolic control. Improvements in contemporary management ameliorates these problems, albeit at the cost of increased exogenous insulin and rising obesity, with emerging reproductive implications. Objective To evaluate changes in body mass index (BMI), and the relationship between obesity, menstrual irregularity and polycystic ovary syndrome (PCOS) in young women with T1D, compared with controls. Methods Longitudinal observational study using data from the Australian Longitudinal Study in Women’s Health of the cohort born in 1989–95, from 2013–2015. Three questionnaires administered at baseline and yearly intervals, were used to evaluate self‐reported menstrual irregularity, PCOS and BMI. Results Overall, 15926 women were included at baseline (T1D, n=115; controls, n=15811). 61 women with T1D and 8332 controls remained at Year 2. Median BMI was higher in women with type 1 diabetes (25.5 vs. 22.9 kg/m², p<0.001), where over half were overweight or obese (54.4% vs. 32.9%, p<0.001). Median BMI increased by 1.11 and 0.45 kg/m², in the T1D and control groups, respectively. T1D was independently associated with an increased risk of menstrual irregularity (RR 1.22, 95%CI 1.02–1.46) and PCOS (RR 2.41, 95%CI 1.70–3.42). Obesity conferred a 4‐fold increased risk of PCOS, compared to those with normal BMI (RR 3.93, 95%CI 3.51–4.42). Conclusions Obesity is prevalent amongst women with T1D, and may be a key contributor to the higher risk of menstrual irregularity and PCOS in this cohort, representing an important opportunity for prevention and intervention.
... It has been documented that being 15% overweight was associated with a significantly higher chance of having a menstrual cycle longer than 43 days. 17 It was observed in the present study that majority (45.2%) perceived their body image as overweight, 36.4% of them thought themselves as average weight and 8% perceived themselves as obese. There was a gross mismatch between perception of their body image and actual weight and this association was found to be statistically significant. ...
Article
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Background: Obesity is on the rise among Indian women; increasing from 12.6% (NFHS-3) to 20.7% (NFHS-4). This leads to dysregulation of several groups of hormones and has deleterious effect on the reproductive system. Extra adipocytes are sources of extra estrogen that can cause menstrual disorders such as oligomenorrhoea, polymenorrhoea, menorrhagia and metrorrhagia. Counselling women about weight reduction will help in improving their reproductive health and quality of life. Thus, the present study was done to assess obesity among women and to describe the menstrual abnormalities among them; simultaneously, the perception of obesity among these women was also assessed. Methods: A cross-sectional study was conducted by doing house to house survey among 250 women of reproductive age residing in the urban field practice area of KIMS, Bangalore for a period of 3 months from June to August 2018. Details about socio-demographic factors, presence of any menstrual abnormalities and perception of obesity were collected using questionnaire by house to house survey. Anthropometric measurements were done and BMI was calculated. Data was entered in MS excel and analysed using appropriate statistical tests. Results: The study included 250 subjects among whom 59.2% were obese. The common menstrual problems reported were dysmenorrhea (52.8%), oligomenorrhea (20.4%), hypomenorrhea (14.1%), menorrhagia (13.6%) and polymenorrhea (1.6%). Menstrual problems affected daily activities in 50.7% subjects. The difference between perception of their body image and their actual weight was found to be statistically significant. Conclusions: Obesity is an important health issue among women and most of them had menstrual abnormalities.
... 21 This may be further explained by: a) negative family history of HMB (60% of adolescents did not have a first-degree relative with HMB and the caregivers of these adolescents were likely unprepared to manage HMB at home); and b) 55% presenting to the ED had anovulatory bleeding (generally deemed difficult to manage with conventional route and doses of hormones). 22 Moreover, 67% of those with anovulatory bleeding were overweight or obese, the latter being associated with gonadal steroid hormone changes that result in disruption of ovulation and menstrual irregularities including HMB. 23,24 Previous studies show that adolescents who present acute symptoms and require hospitalization are more likely to have an underlying BD that was reported only in descriptive analyses, showing 19% and 33% of patients with abnormal uterine bleeding and coagulation disorders when compared with 74% and 67% without, respectively. [25][26][27] When objectively assessing bleeding in patients with BD, consensus guidelines recommend the use of BAT. ...
Article
Heavy menstrual bleeding is common in adolescents. The frequency and predictors of bleeding disorders in adolescents, especially with anovulatory bleeding, are unknown. Adolescents referred for heavy menstrual bleeding underwent an evaluation of menstrual bleeding patterns, and bleeding disorders determined a priori. The primary outcome was the diagnosis of a bleeding disorder. Two groups were compared: anovulatory and ovulatory bleeding. Multivariable logistic regression analysis of baseline characteristics and predictors was performed. Kaplan Meier curves were constructed for the time from the first bleed to bleeding disorder diagnosis. In two-hundred adolescents, a bleeding disorder was diagnosed in 33%(n=67): Low von Willebrand factor levels in 16%; von Willebrand disease in 11% and qualitative platelet dysfunction in 4.5%. The prevalence of bleeding disorder was similar between ovulatory and anovulatory groups (31% vs. 36%; p=0.45). Predictors of bleeding disorder included: younger age at first bleed (OR:0.83; 95% CI:0.73,0.96), Hispanic ethnicity (OR:2.48; 95%CI: 1.3,5.05), non-presentation to emergency department for heavy bleeding (OR:0.14; 95%CI:0.05,0.38) and ISTH-Bleeding Assessment Tool score ≥4(OR: 8.27; 95%CI: 2.60,26.44). Time from onset of the first bleed to diagnosis was two years in the anovulatory, and six years in the ovulatory cohort (log-rank test, P<0.001). There is a high prevalence of bleeding disorders in adolescents with heavy periods, irrespective of the bleeding pattern. Among bleeding disorders, the prevalence of qualitative platelet dysfunction is lower than previously reported.
... Obesity is an independent risk factor for several hormonal abnormalities, such as increased concentrations of testosterone and insulin, and reduced concentrations of the sex hormone-binding globulin [24], which inevitably influences the menstrual cycle. Along with the well-documented increased risk of menstrual irregularity, a limited number of studies reported a higher prevalence of heavy periods among obese women [7,19,25]. ...
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Background Heavy menstrual bleeding (HMB) has been shown to have a profound negative impact on women’s quality of life and lead to increases in health care costs; however, data on HMB among Chinese population is still rather limited. The present study therefore aimed to determine the current prevalence and risk factors of subjectively experienced HMB in a community sample of Chinese reproductive-age women, and to evaluate its effect on daily life. Methods We conducted a questionnaire survey in 2356 women aged 18–50 years living in Beijing, China, from October 2014–July 2015. A multivariate logistic regression model was used to identify risk factors for HMB. Results Overall, 429 women experienced HMB, giving a prevalence of 18.2%. Risk factors associated with HMB included uterine fibroids (adjusted odds ratio [OR] =2.12, 95% confidence interval [CI] = 1.42–3.16, P < 0.001) and multiple abortions (≥3) (adjusted OR = 3.44, 95% CI = 1.82–6.49, P < 0.001). Moreover, women in the younger age groups (≤24 and 25–29 years) showed higher risks for HMB, and those who drink regularly were more likely to report heavy periods compared with never drinkers (adjusted OR = 2.78, 95% CI = 1.20–6.46, P = 0.017). In general, women experiencing HMB felt more practical discomforts and limited life activities while only 81 (18.9%) of them had sought health care for their heavy bleeding. Conclusions HMB was highly prevalent among Chinese women and those reporting heavy periods suffered from greater menstrual interference with daily lives. More information and health education programs are urgently needed to raise awareness of the consequences of HMB, encourage women to seek medical assistance and thus improve their quality of life. Electronic supplementary material The online version of this article (10.1186/s12905-019-0726-1) contains supplementary material, which is available to authorized users.
... Хорошо известно, что у женщин с ожирением часто присутствуют олигоменорея, аменорея или другие варианты нерегулярных менструаций, причем возраст возникновения ожирения и НМЦ значительно коррелируют друг с другом [29]. Эти результаты были подтверждены Jokela М et al. [30], которые показали, что при ожирении в подростковом возрасте увеличивается риск возникновения НМЦ, а число детей у них по достижении репродуктивного возраста меньше на 32-38% по сравнению с подростками с нормальным весом. ...
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Purpose : presentation of modern data on the pathogenesis of menstrual cycle disorders (NMCs) associated with ovulatory dysfunction, and the effectiveness of their treatment with medication. Basic provisions . It is shown that NMC is the result of violations of the cyclic production of gonadotropic and sex hormones. Among the hormonal drugs for the treatment of NMCs, combined estrogen-progestational oral contraceptives (COCs), especially those with drospirenone (DRSP), are advantageous. The introduction of calcium levomefolate - biologically active form of folatein the composition of COCs containing 30 μg of ethinylestradiol and DRSP has a potentiating effect associated with their noncontraceptive effects due to antiandrogenic and antimineralocorticoid activity. It was shown that calcium levomefolate, which participates in human body metabolism, as a component of COC, has a protective effect on the cardiovascular system (due to a decrease in the level of homocysteinemia) in the syndrome of polycystic ovaries, contributes to reducing obesity. Conclusion . The combination of 30EE/DRSP promotes the normalization of the menstrual cycle and has non-contraceptive effects associated with antiandrogenic and antimineralcorticoid action, and fortification with calcium levomefolate also has a positive effect on the hormonal profile and lipid metabolism, has a protective effect on cardiovascular diseases in women with the metabolic syndrome in polycystic ovaries, contributes to the normalization of weight.
... Female spiny mice in the previous cohort were fed a high-energy diet (sunflower seeds, rolled oats, Purina cat chow) and weighed 60-80 g, double the weight of reproductively aged females in our colony (30-40 g). There is evidence in human cohorts of significant increases in overall menstrual cycle length with increased female weight, and indeed amenorrhoea (absence of periods) has been observed on obese women (Harlow & Matanoski 1991, Wei et al. 2009, Seif et al. 2015. In addition, the age of females within the Peitz study was not specified. ...
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We recently discovered the first known menstruating rodent. With the exception of four bats and the elephant shrew, the common spiny mouse (Acomys cahirinus) is the only species outside the primate order to exhibit menses. There are few widely accepted theories on why menstruation developed as the preferred reproductive strategy of these select mammals, all of which reference the evolution of spontaneous decidualisation prior to menstrual shedding. Though menstruating species share several reproductive traits, there has been no identifiable feature unique to menstruating species. Such a feature might suggest why spontaneous decidualisation, and thus menstruation, evolved in these species. We propose that a ≥3-fold increase in progesterone during the luteal phase of the reproductive cycle is a unique characteristic linking menstruating species. We discuss spontaneous decidualisation as a consequence of high progesterone, and the potential role of prolactin in screening for defective embryos in these species to aid in minimising implantation of abnormal embryos. We further explore the possible impact of nutrition in selecting species to undergo spontaneous decidualisation and subsequent menstruation. We summarise the current knowledge of menstruation, discuss current pre-clinical models of menstruation and how the spiny mouse may benefit advancing our understanding of this rare biological phenomenon.
... However, there was no association between menstrual irregularity and body weight changes in the non-obese or non-abdominally obese group. Obesity is associated with many comorbidities and obese women frequently suffer from reproductive disorders, including polycystic ovary syndrome, infertility, and menstrual disorders [15,20,21]. However, how increased body weight or adiposity affects the reproductive axis is not fully understood. ...
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Background Menstrual irregularity is an indicator of endocrine disorders and reproductive health status. It is associated with various diseases and medical conditions, including obesity and underweight. We aimed to assess the association between body weight changes and menstrual irregularity in Korean women. Methods A total of 4,621 women 19 to 54 years of age who participated in the 2010 to 2012 Korea National Health and Nutrition Examination Survey were included in this study. Self-reported questionnaires were used to collect medical information assessing menstrual health status and body weight changes. Odds ratios (ORs) and 95% confidence interval (CI) were calculated to evaluate the association between body weight changes and menstrual irregularity. Results Significantly higher ORs (95% CI) were observed in the association between menstrual irregularity and both weight loss (OR, 1.74; 95% CI, 1.22 to 2.48) and weight gain (OR, 1.45; 95% CI, 1.13 to 1.86) after adjusting for age, body mass index, current smoking, heavy alcohol drinking, regular exercise, calorie intake, education, income, metabolic syndrome, age of menarche, parity, and stress perception. Of note, significant associations were only observed in subjects with obesity and abdominal obesity, but not in non-obese or non-abdominally obese subjects. U-shaped patterns were demonstrated in both obese and abdominally obese subjects, indicating that greater changes in body weight are associated with higher odds of menstrual irregularity. Conclusion We found a U-shaped pattern of association between body weight changes and menstrual irregularity among obese women in the general Korean population. This result indicates that not only proper weight management but also changes in body weight may influence the regulation of the menstrual cycle.
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Introduction: The regularity of menstrual cycles is considered an important indicator of women’s reproductive health. Menstrual disorders such as dysmenorrhea, menorrhagia, and irregular cycles are common among women in reproductive age groups. They are responsible for physical, behavioural, and emotional changes around the menstruation period, leading to changes of normal routine. This study aimed to determine different types of menstrual irregularity, demographic association, self-esteem, and quality of life of women experiencing menstrual disorders at reproductive age. Methods: A cross-sectional study was conducted using the adopted Rosenberg Self-Esteem Score (RSES) and World Health Organization Quality of Life Assessment (WHOQOL-BREF) questionnaire among 253 women aged 18 to 49 who attended the Gynaecology Clinic at a public hospital in Klang Valley. Results: Dysmenorrhea was observed in 224 (88.5%) women. The majority of the respondent have a normal self-esteem level based on RSES score. The respondent’s quality of life (QOL) score was average between 58 to 62%. Finding revealed a direct linear relationship between self-esteem and quality of life among respondents (p<0.001). According to the domain QOL, positive association for QOL was found with age, educational level, marital status, and body mass index (p<0.005), respectively with physical, social relationship and environment domain. Conclusion: There is a need for the Ministry of Health to evaluate current practice for improving women’s reproductive health through menstruation-efficient interventions, to prevent the negative impact on self-esteem and quality of life. Future research should explore in-depth women’s perceptions to understand better how menstrual problems affect their self-esteem and quality of life.
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Background. Due to the increasing prevalence of abnormal uterine bleeding (AUB) among obese adolescent girls, a factorial analysis of the probable causes of this pathology is highly relevant. Aim. To analyze and characterize clinical, hormonal, metabolic features and parameters relevant to the assessment of ovarian reserve in adolescent girls with obesity and AUB. Materials and methods. The study included 2 groups of obese adolescent girls who have passed at least 12 months from the start of menarche, who do not have endocrine and severe somatic diseases; main group: adolescent girls with obesity (SDS BMI more than 2) and abnormal uterine bleeding of the type of opso-oligomenorrhea and secondary amenorrhea; comparison group: adolescent girls with obesity (SDS BMI more than 2) and absence of menstrual cycle disorders. Results. Among adolescent girls without AUB, severe forms of obesity (34 art.) were more common than in the group with AUB. According to the metabolic status, plasma triglyceride and cholesterol levels were significantly higher in the AUB group compared with adolescent girls without menstrual disorders (p=0.035 and 0.043, respectively).When assessing carbohydrate metabolism, no significant differences between the groups were obtained (p=1.000). According to the results of the study of the hormonal status, no significant differences between the groups were obtained. The hirsute number had no significant differences in the groups. The correlation analysis revealed a positive correlation between the severity of obesity with the HOMA index (p=0.034), a positive correlation of the prolactin level with the hirsute number (p=0.021) and estradiol (p=0.04). The median level of anti-muller hormone in the group with AUB was significantly higher compared to the group without AUB (6.13 ng/ml vs 2.09 ng/ml, p0.05). When analyzing the follicular apparatus of the ovaries, it was found that the median volume of both the right and left ovaries in girls of group 1 with obesity and the AUB was larger than in the comparison group. The median number of follicles in the section in group 1 also indicated a greater number of them compared to the comparison group. Conclusion. In the studied groups, girls with a more severe degree of obesity were more often associated with the absence of AUB, but metabolic disorders were more common in the group of girls with AUB. When assessing the ovarian reserve, a direct correlation was obtained between the level of anti-muller hormone and the number of antral follicles in the ovary.
The prevalence of childhood and adolescent obesity has significantly increased in the United States and worldwide since the 1970s, a trend that has been accelerated by the COVID-19 pandemic. The complications of obesity range from negative effects on the cardiovascular, endocrine, hepatobiliary, and musculoskeletal systems to higher rates of mental health conditions such as depression and eating disorders among affected individuals. Among adolescent girls, childhood obesity has been associated with the earlier onset of puberty and menarche, which can result in negative psychosocial consequences, as well as adverse effects on physical health in adulthood. The hormones leptin, kisspeptin and insulin, and their actions on the hypothalamic-pituitary-ovarian axis, have been implicated in the relationship between childhood obesity and the earlier onset of puberty. Obesity in adolescence is also associated with greater menstrual cycle irregularity and the polycystic ovary syndrome (PCOS), which can result in infrequent or absent menstrual periods, and heavy menstrual bleeding. Hyperandrogenism, higher testosterone and fasting insulin levels, and lower levels of sex hormone-binding globulin, similar to the laboratory findings seen in patients with PCOS, are also seen in individuals with obesity, and help to explain the overlap in phenotype between patients with obesity and those with PCOS. Finally, obesity has been associated with higher rates of premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder, and dysmenorrhea, although the data on dysmenorrhea appears to be mixed. Discussing healthy lifestyle changes and identifying and managing menstrual abnormalities in adolescents with obesity are key to reducing the obstetric and gynecologic complications of obesity in adulthood, including infertility, pregnancy complications, and endometrial cancer.
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Treatment of mouse preimplantation embryos with elevated palmitic acid (PA) reduces blastocyst development, while co-treatment with PA and oleic acid (OA) together rescues blastocyst development to control frequencies. To understand the mechanistic effects of PA and OA treatment on early mouse embryos, we investigated the effects of PA and OA, alone and in combination, on autophagy during preimplantation development in vitro. We hypothesized that PA would alter autophagic processes and that OA co-treatment would restore control levels of autophagy. Two-cell stage mouse embryos were placed into culture medium supplemented with 100 μM PA, 250 μM OA, 100 μM PA and 250 μM OA, or KSOMaa medium alone (control) for 18 - 48 h. The results demonstrated that OA co-treatment slowed developmental progression after 30 h of co-treatment but restored control blastocyst frequencies by 48 h. PA treatment elevated LC3-II puncta and p62 levels per cell while OA co-treatment returned to control levels of autophagy by 48 h. Autophagic mechanisms are altered by non-esterified fatty acid (NEFA) treatments during mouse preimplantation development in vitro, where PA elevates autophagosome formation and reduces autophagosome degradation levels, while co-treatment with OA reversed these PA-effects. Autophagosome-lysosome co-localization only differed between PA and OA alone treatment groups. These findings advance our understanding of the effects of free fatty acid exposure on preimplantation development, and they uncover principles that may underlie the associations between elevated fatty acid levels and overall declines in reproductive fertility.
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Ethnopharmacological relevance Amenorrhea caused by antipsychotic drugs is not uncommon in clinical practice, and various treatment strategies are used to treat the condition. Chinese herbal medicine has its own theory for amenorrhea caused by antipsychotic drugs and has developed its own medication methods. Aim of the study To review and conduct meta-analysis of the use of traditional Chinese herbal medicine in treatment of amenorrhea caused by antipsychotic drugs. Materials and methods A search was conducted across seven Chinese electronic databases (the China National Knowledge Infrastructure (CNKI) database, the China Science and Technology Journal Database, the Wanfang Database, the SinoMed, the Foreign Medical Literature Retrieval Service(FMRS), the Chinese University of Hong Kong Library, the Airiti Library), and the following English databases: MEDLINE, PreMEDLINE, OLD MEDLINE、Publisher Supplied Citation in pubmed; JBI EBP Database, EBM Reviews, Embase, OVID Emcare, Ovid MEDLINE(R), Maternity & Infant Care Database(MIDIRS), APA PsycInfo in OVID, and Cochrane Database of Systematic Reviews (Cochrane Reviews), Database of Abstracts of Reviews of Effects (Other Reviews), Cochrane Central Register of Controlled Trials (Clinical Trials),The Cochrane Methodology Register (Method Studies), Health Technology Assessment Database (Technology Assessments), NHS Economic Evaluation Database (Economic Evaluations) in Cochrane Library; and four databases (Science Direct, ProQuest, Web of Science, and Scopus) in official website using common standards and inclusion/exclusion criteria. The remaining reports were used for preliminary studies. Due to inconsistencies in control groups, randomized controlled trials and articles that combined with other drugs were also excluded. This study is a META analysis of a single rate. Results Initial screening returned 912 potentially relevant publications in all databases. After subsequent filtering, a total of 18 articles were included in the analysis. The overall effectiveness for treatment amenorrhea caused by antipsychotic drugs using traditional Chinese herbal medicine was 0.91, with 95% confidence interval of 0.89–0.93. Notably in most studies, the time needed to achieve this level of effectiveness was relatively long, usually in excess of three months. Although a satisfactory verification of an improvement in menstrual cycling takes time, the long treatment duration is a downside. Our analysis revealed that the following Chinese herbal remedies were most common: Danggui (Angelica sinensis (Oliv.) Diels), Chuanxiong (Ligusticum striatum DC.), Taoren (Prunus persica (L.) Batsch), Honghua (Carthamus tinctorius L.), Gancao (Glycyrrhiza uralensis Fisch.), Fuling ((Fungus) Poria cocos (Schw.) Wolf), Baizhu (Atractylodes macrocephala Koidz.), Xiangfu (Cyperus rotundus L.), Chaihu (Bupleurum chinense DC.), Shudihuang (Rehmannia glutinosa (Gaertn.) DC.(Processed), Baishao (Cynanchum otophyllum C.K.Schneid.) Conclusions Chinese herbal medicine can effectively treat amenorrhea caused by psychiatric drugs, although it takes a long time to achieve satisfactory effectiveness. More research is needed to better understand different aspects of Chinese herbal medicine use in treatment of this particular medical condition.
Article
Objective To study whether artificial intelligence (AI) technology can be used to discern quantitative differences in endometrial immune cells between cycle phases and between samples from women with polycystic ovary syndrome (PCOS) and non-PCOS controls. Only a few studies have analysed endometrial histology by utilizing AI technology, and especially studies of the PCOS endometrium are lacking, partly due to the technically challenging analysis and unavailability of well-phenotyped samples. Novel AI technologies can overcome this problem. Design Case-control study Setting University hospital -based research laboratory Patients 48 women with PCOS and 43 controls. Proliferative phase samples (26 control, 23 PCOS) and luteinizing hormone (LH) surge timed LH+ 7–9 (10 control, 16 PCOS) and LH+ 10–12 (7 control, 9 PCOS) secretory endometrial samples were collected during 2014–2019. Interventions None Main Outcome Measure(s) Endometrial samples were stained with antibodies for CD8+ T cells, CD56+ uterine natural killer (uNK) cells, CD68+ macrophages, and proliferation marker Ki67. Scanned whole slide images (WSIs) were analysed with an AI deep learning model (AINO, Aiforia). Cycle phase differences in leucocyte counts, proliferation rate, and endometrial thickness were measured within the study populations and between PCOS and control samples. A sub-analysis of anovulatory PCOS samples (n = 11) vs. proliferative phase controls (n =18) was also performed. Results Automated cell counting with a deep learning model performs well for the human endometrium. Leucocyte numbers and proliferation in the endometrium fluctuate with the menstrual cycle. Differences in leucocyte counts were not observed between the whole PCOS population and the controls. However, anovulatory women with PCOS presented with a higher number of CD68+ cells in the epithelium (controls vs. PCOS, median [IQR] 0.92 [0.75–1.51] vs. 1.97 [1.12–2.68], p = 0.025) and fewer leucocytes in the stroma (CD8% 3.72 [2.18–4.20] vs 1.44 [0.77–3.03], p = 0.017; CD56% 6.36 [4.43–7.43] vs. 2.07 [0.65–4.99] p = 0.003; CD68% 4.57 [3.92–5.70] vs 3.07 [1.73–4.59], p = 0.022, respectively) compared with the controls. Endometrial thickness and proliferation rate were comparable between the PCOS and control groups in all cycle phases. Conclusion(s) AI technology provides a powerful tool for endometrial research as it is objective and can efficiently analyse endometrial compartments separately. Ovulatory endometrium from women with PCOS did not differ remarkably from the controls, which might indicate that gaining ovulatory cycles normalizes the PCOS endometrium and enables normalization of leucocyte environment prior to implantation. Deviant endometrial leucocyte populations seen in anovulatory women with PCOS could interrelate with the altered endometrial function observed in these women.
Article
Background Bariatric surgery is an effective treatment for severe obesity. Several studies have been conducted on the effects of bariatric surgery on the reproductive function of obese patients without Polycystic Ovary Syndrome (PCOS). Objective To evaluate the effects of bariatric surgery on the menstruation and reproductive related hormones of obese women of childbearing age without PCOS. Setting A Systematic review and meta-analysis. University Hospital. Methods Online databases were searched for all studies reporting the efficacy of bariatric surgery for obese women until March 2021. The language of publication was limited to English and Chinese. Incidence of abnormal menstruation and reproductive related hormone levels were the primary outcomes. Results Fifteen studies comprising 725 patients were enrolled in this meta-analysis. Results showed a significantly lower incidence of abnormal menstruation (relative risk: 0.40, 95% confidence interval [CI]: 0.20–0.79, P=0.008) after bariatric surgery. Moreover, bariatric surgery led to a decrease in serum insulin levels (mean difference [MD] = -13.12 mIU/L, 95% CI: -15.03–-11.22, P<0.00001), glucose (MD = -0.91 mmol/L, 95% CI: -1.26–-0.56, P<0.00001), triglyceride (MD = -0.61 g/L, 95% CI: -0.76–-0.46, P<0.00001), total testosterone (MD = -0.22 ng/mL, 95% CI: -0.24–-0.20, P<0.00001), dehydroepiandrosterone (DHEA) (MD = -25.34 μg/dL, 95% CI: -31.19–-19.49, P<0.00001), estradiol (MD = -25.13 pg/mL, 95% CI: -34.13–-16.13, P<0.00001), and anti-Mullerian hormone (AMH) (MD = -0.40 ng/mL, 95% CI: -0.67–-0.13, P = 0.003). Serum sex hormone binding globulin (SHBG) levels increased after bariatric surgery (MD = 43.99 nmol/L, 95% CI: 34.99–52.99, P<0.00001). Conclusion Bariatric surgery can lower fasting insulin, glucose and triglyceride levels, reduce the incidence of abnormal menstruation, decrease total serum testosterone, DHEA, estradiol, and AMH levels, and increase SHBG level for obese women without PCOS of childbearing age. This meta-analysis indicated that bariatric surgery could be effective in improving reproductive function for severely obese women.
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Primary and secondary amenorrhea in adolescents spans a broad differential ranging from non-pathologic to rare disorders that may be encountered only once in a lifetime of practice. This article aims to provide a systematic approach to amenorrhea, with the goal of organizing the etiologies of amenorrhea in a way that focuses the provider on the appropriate evaluation and management pathways. Primary and secondary amenorrhea are common problems presented to clinicians. Too often, providers eschew a full workup prior to initiating a patient on hormone medications to induce or regulate the menstrual cycle. If, instead, the menstrual cycle is approached as a “vital sign,” then it follows that the absence of menses is an important clinical indicator that warrants thorough investigation and, if necessary, referral to a specialist.
Article
Objectives To evaluate in a sample of Chilean adult women, the association between adiposity markers with pattern and length of the menstrual cycle, assessing the influence of metabolic markers and hormones in this relationship. Study design We conducted a cross-sectional study involving 401 premenopausal women belonging to the DERCAM study (Determinants of Breast Cancer Risk) from Santiago, Chile. The menstrual cycle pattern was defined as regular or irregular, while menstrual cycle length was categorized as short (≤25 d), normal (26-31d), and long (≥32d). Adiposity markers included body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), and body fat percentage (BFP). Insulin, sex-hormone-binding globulin (SHBG), estrone (E1), estradiol (E2), androstenedione (A2), follicle-stimulating hormone (FSH) and progesterone were measured in the follicular phase of the menstrual cycle. Results There was no association between adiposity markers and cycle patterns. However, after all, metabolic and hormonal adjustments, women in the third tertile of BFP (RRR = 2.63; 95% CI: 1.21.5.69) were more likely to have longer menstrual cycles. Conclusion Women with high BFP presented a higher risk of having irregular menstrual cycles, which was an indicator of reproductive disorders; this relationship could be partially mediated by hormonal markers, especially SHBG, E1, and insulin levels.
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Wie in allen Ländern der westlichen Welt steigt die Prävalenz von Übergewicht und Adipositas auch in der Schweiz. Zugleich zeigt sich, dass adipöse Frauen häufiger unerwartet und ungewollt schwanger werden als normalgewichtige Frauen (1). Die unzureichende Applikation effektiver Kontrazeptionsmethoden liegt zum einen an pathophysiologischen Besonderheiten, zum anderen aber auch an psychosozialen Faktoren. All das ist bei einer adäquaten Kontrazeptionsberatung zu berücksichtigen.
Chapter
Secondary amenorrhea occurs in 3–5% of women and is defined as the absence of menses for three cycles or 3–6 months in previously menstruating women. After excluding pregnancy, the most common causes include hypothalamic suppression, polycystic ovary syndrome, primary ovarian insufficiency, hyperprolactinemia, and thyroid dysfunction. All women presenting to primary care with secondary amenorrhea should be evaluated with a history and physical exam targeted to potential physiologic, anatomical, gynecologic, and endocrine causes of their symptoms. A first-line workup should include pregnancy testing along with serum FSH, TSH, and prolactin. Additional testing, including a progestin withdrawal challenge, androgens, and imaging, should be based upon suspected etiology. Treatment centers on addressing the underlying condition with involvement of specialists for medical, procedural, or surgical management as appropriate.
Article
Objective: to assess the reproductive health features of women with fat metabolism disorders and the safety of using combined oral contraception in them. Materials and methods. 150 women of childbearing age (mean age 29.8 ± 4.7 years) were examined, which were divided into three groups depending on the type of impaired fat metabolism: the first group included patients with obesity and dyslipidemia (n = 50); the second group – women with obesity without dyslipidemia (n = 46); the third group – patients with a normal body mass index and dyslipidemia (n = 54). All patients underwent clinical and laboratory examination with the assessment of biochemical, metabolic and hormonal blood parameters. At the second stage of the study, the safety assessment of the use of combined oral contraceptive with chlormadinone acetate (COC–CMA) in women in need of pregnancy protection was performed. Results. Women with fat metabolism disorders have a high prevalence of menstrual irregularities. The most commonly detected were polycystic ovary syndrome (PCOS), phenotypes A, C, D. In the absence of PCOS in obese women or patients with dyslipidemia at normal weight, the formation of endocrine pathology was observed, associated with hyperandrogenemia or a tendency to hypogonadotropic hypogonadism. Patients with obesity and dyslipidemia had the worst fertility profile and high prevalence of infertility and miscarriage. Taking COC–CMA did not have a significant effect on fat metabolism. Conclusion. Dyslipidemia and obesity are independent factors in reproductive health problems. Clinical portraits of gynecological endocrine pathology in patients with obesity, dyslipidemia and their combination are different. The assessment of carbohydrate and fat metabolism should be considered one of the important components of the examination of patients with menstrual dysfunction or impaired fertility. COC–CMA can be considered the drug of choice for contraception in women with impaired fat metabolism.
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Purpose: This study was performed to identify the prevalence of menstrual disorders in Korean women based on body mass index (BMI) and lifestyle factors, by utilizing the Korean National Health Insurance Database. Methods: A retrospective observational study design was used for the secondary data analysis. Data of women aged 15 to 49 years who were diagnosed with menstrual disorders were extracted from The National Health Insurance Service-National Health Screening Cohort in Korea from 2009 to 2016. The age-standardized prevalence rate of menstrual disorders was calculated using SAS version 9.4, and a Chi-square test and Cochran-Armitage test were performed. Results: In total, 2,219,445 cases were extracted from the database. The prevalence of menstrual disorders significantly increased from 8.6% to 11.6% (Z=135.16, p for trend <.001) over the past eight years. In particular, it was higher in underweight women than in women with normal weight across all years (Z=-4.18~-14.72, p<.001). Moreover, statistically significant differences in the prevalence of menstrual disorders were found to be associated with drinking and smoking in all years and with physical activity levels in part (p<.05~.001). Conclusion: These findings present compelling evidence on the prevalence of menstrual disorders based on a national database. Since the prevalence of menstrual disorders has steadily increased and differs based on BMI and lifestyle factors, educational and clinical interventions are necessary to promote risk awareness and appropriate behavioral changes among Korean women.
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PURPOSE The purpose of this study was to investigate the level of lipids and adipokines according to the menstrual cycle (follicular and luteal phase) and to investigate the effect of resistance exercise on the change of lipids and adipokines according to menstrual cycle. METHODS The subjects were living in C city and body fat of over 30% in the obesity college women students (n=30). These were divided into the follicular phase group (n=15) and the luteal phase group (n=15) by random sampling. All the contents of the study were approved by Kangwon National University IRB and applied to the guidelines for personal safety. RESULTS There was no interaction effect between group and time on body composition, lipid profiles and adipokines. Body composition showed a significant decrease in body percent fat in both groups. After the exercise program, there was a significant difference between groups in body percent fat. Also, TC was significantly decreased after 16 weeks compared with 0 week. Leptin concentration was significantly higher in the luteal group than in the follicular group and was significantly decreased after 16 weeks of exercise program in the luteal group. Adiponectin concentration was also significantly higher in the luteal group than in the follicular group, but in the luteal group, there was a significantly increase after 16 weeks of exercise program compared 0 week. CONCLUSIONS This study suggests that the concentration of aidpokine in the luteal phase is higher than that of the follicular phase and that the timing of blood collection is very important for women. Resistance exercise seems to have an effect on adipokine concentration.
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Introduction: The purpose of the present study was to assess the prevalence and determinants of menstrual cycle disorders among women with epilepsy. Materials and methods: The study included consecutive women with epilepsy who visited a university epilepsy clinic. A number of variables, including demographics, characteristics of epilepsy and its treatment, and data related to reproductive health (regularity of menstrual cycle, number of pregnancies and childbirths), were collected from medical records, seizure diaries, and a dedicated questionnaire. Results: The study involved 271 women with epilepsy. Focal epilepsy was diagnosed in 182 (67.2%) patients; 108 (39.8%) women had rare seizures (<1 per year), and 164 patients (60.5%) were on monotherapy. Menstrual abnormalities were found in 78 patients (28.8%). Independent variables associated with irregular cycle included younger age at onset of epilepsy (OR=0.95 per 1-year increase; P=0.008), current use of clonazepam (OR=5.36; P=0.010), and chronic use of medication(s) other than antiepileptic drug(s) (AEDs; OR=2.48; P=0.003). Childbirth rate was low in our cohort (0.50 per patient); independent predictors of being childless in studied patients included younger age, presence of menstrual disorders, and greater number of currently used AEDs. Conclusion: Menstrual disturbances were present in 28.8% of studied women with epilepsy. Increased prevalence of menstrual abnormalities was associated with epilepsy itself (younger age at onset of epilepsy) and its treatment (ongoing use of clonazepam), as well as with chronic use of medications other than AEDs.
Article
Introduction There is a well-established inverse relationship between body mass index and frequency of endometriosis. However, these population-based studies have relied mostly on self-reported cases of endometriosis, rather than surgically confirmed endometriosis where disease severity has been objectively assessed. The aim of the current retrospective study was to establish whether the established relationship between endometriosis and low body mass index was independent of disease severity. Methods Women with menstrual and/or pelvic pain undergoing laparoscopy for suspected endometriosis were recruited for this retrospective study (n = 509). Women were grouped by body mass index (kg/m ² ) according to World Health Organization criteria: underweight (<18.5), normal (18.5–24.99), pre-obese (25–29.99) or obese (≥30). Endometriosis was scored according to the revised American Fertility Society system. Data were analysed based on body mass index and endometriosis status to identify any relationship between body mass index and disease. Results The average body mass index of women with endometriosis was 25.0 kg/m ² . The body mass index distribution of women with endometriosis differed relative to women in the general population. As expected, fewer obese women had endometriosis than in the lower body mass index categories. However, the obese women who did have endometriosis had significantly higher revised American Fertility Society scores compared to women with normal and pre-obese body mass indices. Discussion Our results are consistent with the established finding of an inverse relationship between body mass index and endometriosis. The novel finding from this study is that obesity is associated with increased disease severity and reduced frequency of stage I endometriosis. It remains unclear what role body mass index has in the cause or effect of endometriosis; we speculate that body mass index may be useful for sub-classifying the disease.
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Tranexamic acid has proven to be an effective treatment for heavy menstrual bleeding (HMB). It reduces menstrual blood loss (MBL) by 26%-60% and is significantly more effective than placebo, nonsteroidal anti-inflammatory drugs, oral cyclical luteal phase progestins, or oral etamsylate, while the levonorgestrel-releasing intrauterine system reduces MBL more than tranexamic acid. Other treatments used for HMB are oral contraceptives, danazol, and surgical interventions (endometrial ablation and hysterectomy). Medical therapy is usually considered a first-line treatment for idiopathic HMB. Tranexamic acid significantly improves the quality of life of women treated for HMB. The recommended oral dosage is 3.9-4 g/day for 4-5 days starting from the first day of the menstrual cycle. Adverse effects are few and mainly mild. No evidence exists of an increase in the incidence of thrombotic events associated with its use. An active thromboembolic disease is a contraindication. In the US, a history of thrombosis or thromboembolism, or an intrinsic risk for thrombosis or thromboembolism are considered contraindications as well. This review focuses on the efficacy and safety of tranexamic acid in the treatment of idiopathic HMB. We searched for medical literature published in English on tranexamic acid from Ovid Medline, PubMed, and Cinahl. Additional references were identified from the reference lists of articles. Ovid Medline, PubMed, and Cinahl search terms were "tranexamic acid" and "menorrhagia" or "heavy menstrual bleeding." Searches were last updated on March 25, 2012. Studies with women receiving tranexamic acid for HMB were included; randomized controlled studies with a description of appropriate statistical methodology were preferred. Relevant data on the physiology of menstruation and the pharmacodynamics and pharmacokinetics of tranexamic acid are also included.
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Adolescent obesity has dramatically increased in recent decades, and along with that so have other medical comorbidities, such as hypertension, diabetes, hyperlipidemia, nonalcoholic steatohepatitis, polycystic ovary syndrome (PCOS), and pseudotumor cerebri. Obesity and related comorbidites may be contraindications to hormonal contraception, making contraception counseling of morbidly obese adolescents more challenging. Obese adolescent females seeking bariatric surgery need effective contraception in the postoperative period. This study is designed to determine the acceptance rate of the levonorgestrel-releasing intrauterine device (IUD) and describe common menstrual problems in obese adolescent bariatric surgery patients. This is a historic cohort study of adolescent females who underwent bariatric surgery over a 2-year period at a tertiary referral center for pediatric obesity. Data were systematically abstracted. The percent of patients with menstrual problems and the acceptance rate for the levonorgestrel-releasing IUD were determined. Twenty-five adolescents met inclusion criteria. The mean age was 17.4 years (standard deviation [SD] 2.6), and the mean body mass index (BMI) was 51.4 (SD 6.3) kg/m(2). Eighty-four percent were white. Twenty-eight percent had menorrhagia, 32% had oligomenorrhea, 40% had dysmenorrhea, and 36% had PCOS. Ninety-two percent (23 of 25) underwent IUD placement. There was a high prevalence of menstrual problems among this sample of severely obese adolescent females. The majority accepted the IUD, indicating it is a viable option among this population.
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Hartz A. J., D. C. Rupley and A. A. Rlmm (The Medical College of Wisconsin, P.O. Box 26509, Milwaukee, Wl 53226). The association of girth measurements with disease in 32, 856 women. Am J Epidemiol 1984;119:71–80. Most epidemiologic studies which evaluate the association between obesity and disease consider only total adipose tissue and ignore its distribution. The present study used data from a national survey of women in TOPS (a weight reduction organization) in 1969. The purpose of this study was to evaluate the distribution of adipose tissue as a risk factor for disease using girth, height, and weight measurements in 21, 065 women 40–59 years of age and 11, 791 women 20–39 years of age. it was found that an index of body fat distribution, the ratio of waist girth to hip girth, was significantly associated with diabetes, hypertension, and gallbladder disease in women aged 40–59 and with menstrual abnormalities in women aged 20–39. Relatively more fat around the waist (as compared to hips) was associated with higher disease prevalence even among women with comparable total body fat These findings suggest that indices based only on weight and height may not adequately characterize the risks associated with obesity.
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To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates. Prospective observational study. 11 general practices from the Somerset Morbidity Project. 885 women consulting their general practitioner with menorrhagia over four years. Proportions of these women investigated and treated with drugs in primary care, referred to a gynaecologist and undergoing operative procedures. The relation between investigation and prescribing in primary care and referral to and surgery in secondary care. Less than half of women had a vaginal examination (42%, 95% CI 39% to 45%), or a full blood count (39%, 95% CI 36% to 43%). Almost a quarter of women, 23% (95% CI 20% to 26%), received no drugs and 37% (95% CI 34% to 40%) received norethisterone. Over a third, 38% (95% CI 34% to 40%), of women were referred, and once referred 43% (95% CI 38% to 48%) of women were operated on. Women referred to a gynaecologist were significantly more likely to have received tranexamic acid and/or mefenamic acid in primary care (chi(2)=16.4, df=1, p<0.001). There were substantial between practice variations in management, for example in prescribing of tranexamic acid and/or mefenamic acid (range 16% to 72%) and referral to gynaecology (range 24% to 52%). There was a significant association between high referral and high operative rates (Spearman's correlation coefficient=0.86, p=0.001). Substantial differences in management exist between practices when investigating and prescribing for menorrhagia in primary care. Rates of prescribing of effective medical treatment remain low. The decision to refer a woman impacts markedly on her chances of subsequently being operated on. Effective management in primary care may not reduce referral or hysterectomy rates.
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Surgical treatment of menorrhagia is likely to be both successful and satisfactory to the patient. Correct diagnosis of the cause of menorrhagia is essential, and management should be directed to the specific cause of the problem. The question of which treatment is best is a complex one and involves balancing patient wishes, expected outcomes, complications, cost-effectiveness and quality of life issues. For the subset of women in whom dysfunctional uterine bleeding is diagnosed, the literature suggests that there is a hierarchy of treatments that, in descending order for both efficacy and patient acceptability, are: (i) hysterectomy; (ii) endometrial ablation (either first- or second-generation); (iii) the levonorgestrel intrauterine system; and (iv) medical treatments. All four of these options should be discussed with the patient and the relative advantages and disadvantages considered before a treatment decision is made. For patients in whom a pathological cause is diagnosed, specific treatments should be aimed at removal of the lesion and observation of the effect on menstrual status. In addition to the treatment options above, specific treatments such as hysteroscopic, laparoscopic or open excision of the lesion need to be considered. For interventional radiological procedures such as uterine artery embolization, further study is recommended before it can be considered as a safe and effective treatment for menorrhagia.
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It has been reported that women with polycystic ovary syndrome (PCOS) benefit from metformin therapy. A randomized, placebo-controlled, double-blind study of obese (body mass index >30 kg/m2), oligo-/amenorrhoeic women with PCOS. Metformin (850 mg) twice daily was compared with placebo over 6 months. All received the same advice from a dietitian. The primary outcome measures were: (i) change in menstrual cycle; (ii) change in arthropometric measurements; and (iii) changes in the endocrine parameters, insulin sensitivity and lipid profile. A total of 143 subjects was randomized [metformin (MET) = 69; placebo (PL) = 74]. Both groups showed significant improvements in menstrual frequency [median increase (MET = 1, P < 0.001; PL = 1, P < 0.001)] and weight loss [mean (kg) (MET = 2.84; P < 0.001 and PL = 1.46; P = 0.011)]. However, there were no significant differences between the groups. Logistic regression analysis was used to analyse the independent variables (metformin, percentage of weight loss, initial BMI and age) in order to predict the improvement of menses. Only the percentage weight loss correlated with an improvement in menses (regression coefficient = 0.199, P = 0.047, odds ratio = 1.126, 95% CI 1.001, 1.266). There were no significant changes in insulin sensitivity or lipid profiles in either of the groups. Those who received metformin achieved a significant reduction in waist circumference and free androgen index. Metformin does not improve weight loss or menstrual frequency in obese patients with PCOS. Weight loss alone through lifestyle changes improves menstrual frequency.
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Obesity significantly increases risk for mortality and morbidity in women and is associated with several gynecologic and reproductive disorders, including infertility. Obesity, and the resultant hyperinsulinemia and hyperandrogenemia, negatively affects menstrual function, ovulation, and fertility. It can increase risk for complications during fertility treatments and reduce responsiveness to these treatments. Current recommendations suggest that modest weight losses are effective in improving hormonal profiles, menstrual regularity, ovulation, pregnancy rates, and reducing pregnancy-related complications and costs. Behavioral treatment programs that focus on eating a healthy diet and increasing physical activity can be useful in promoting and maintaining weight loss in obese, infertile women.
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A randomized, double blind, group comparative study was performed over a 12 month period to compare inhibition of ovulation during the use of two (progestogen-only) oral contraceptives containing doses of 75 μg desogestrel or 30 μg levonorgestrel. Seventy-one female volunteers with regular cycles and established ovulation by ultrasonography and serum progesterone concentrations were recruited from an out-patient clinic in a university hospital and asked to participate in the study. Transvaginal ultrasonography and serum oestradiol, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH) measurements were performed throughout the 7th and 12th 28 day treatment period. Desogestrel at a dose of 75 μg showed a significant inhibition of ovulation compared to 30 μg levonorgestrel (P < 0.001).
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Objective: To compare the efficacy and safety of endometrial ablation (EA) among obese versus non-obese women. Methods: A retrospective cohort study of 666 women who underwent EA at the Mayo Clinic, Rochester, USA, between January 1, 1998, and December 31, 2005, was conducted. Obesity was defined as a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of 30 or above. Outcome measures included treatment failure and amenorrhea. Regression models were used to compare outcomes and adjust for known confounders. Results: The mean BMI was 29.6±7.7; 263 women (39.5%) were classified as obese. No difference was observed in treatment failure at 5 years between the obese and non-obese cohorts (11.6% vs 9.7%) with an adjusted hazard ratio of 0.96 (95% confidence interval [CI], 0.60-1.53; P=0.878). The crude 12-month amenorrhea rate was higher among non-obese than obese women (24.3% vs 17.5%); however, this difference was not significant after adjusting for known predictors of amenorrhea. The odds ratio was 1.28 (95% CI, 0.75-2.19; P=0.366). Adverse events were rare and comparable between the cohorts. Conclusion: The use of EA is a safe and effective option for women with obesity.
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We sought to examine the pharmacokinetics and acceptability of the etonogestrel contraceptive implant in obese women. We developed and validated a plasma etonogestrel concentration assay and enrolled 13 obese (body mass index ≥30) women and 4 normal-weight (body mass index <25) women, who ensured comparability with historical controls. Etonogestrel concentrations were measured at 50-hour intervals through 300 hours postinsertion, then at 3 and 6 months to establish a pharmacokinetic curve. All obese participants were African American, while all normal-weight participants were white. Across time, the plasma etonogestrel concentrations in obese women were lower than published values for normal-weight women and 31-63% lower than in the normal-weight study cohort, although these differences were not statistically significant. The implant device was found highly acceptable among obese women. Obese women have lower plasma etonogestrel concentration than normal-weight women in the first 6 months after implant insertion. These findings should not be interpreted as decreased contraceptive effectiveness without additional considerations.
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Background: Progestin-only contraceptive pills (POPs) offer a safe and effective contraceptive option, particularly for women at increased risk of venous thromboembolism. However, the prevalence of POP use among women in the United States is unknown. Study design: We analyzed population-based data from 12,279 women aged 15-44 years in the National Survey of Family Growth. Data were collected continuously from 2006 to 2010 by in-person, computerized household interviews. Analyses describe POP use across sociodemographic and reproductive characteristics and thromboembolic risk profiles. Results: Overall, 0.4% of all reproductive-aged women in the United States currently use POPs. POP use was higher among parous, postpartum and breastfeeding women than their counterparts (all p values<.001). Women at higher risk of thromboembolism (older, obese, diabetic or smoking women) had similar proportions of POP use as women without those risks. Conclusion: POPs are rarely used by US women. While data on chronic disease were limited, our results suggest that relatively few women with increased risk of thromboembolism are considering POPs when choosing an oral contraceptive.
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This study investigated the satisfaction of women carrying the LNG-IUD and determined influencing factors, especially considering bleeding patterns and body mass index (BMI). Cross sectional study. Gynecological offices in a Central European district. 1825 women aged between 18 and 60 years. While sitting in the waiting room, voluntary patients had to answer a questionnaire about their experiences with the levonorgestrel intrauterine device. One question was used to determine whether the women were current, former or not users of the intrauterine coil. 415 women who had some experiences with Mirena were found. Overall, 266 (65.7%) were "very satisfied," 83 (20.5%) "quite satisfied," 18 (4.4%) "moderate satisfied," 19 (4.7%) "less satisfied," and the same amount "really not satisfied" with the hormonal coil. Women with amenorrhea were more often "very satisfied" in general, than women with hypermenorrhea (178 (67.9%) vs. 3 (1.1%) p < 0.001). Concerning bleeding patterns, 295 (74.1%) were "very satisfied" and 23 (5.8%) "really not satisfied". 203 (91.0%) of all amenorrhoeic women were "very satisfied" with their bleeding patterns, but only 2 (9.5%) of all women with hypermenorrhea (p < 0.001 for α = 0.05). Amenorrhea particularly occurred in women who had a significantly lower body mass index (24.4 ± 4.4 kg/m(2) vs. 27.6 ± 6.5 kg/m(2) in women with hypermenorrhea, p = 0.018 for α = 0.05). After allocating women to the widely used BMI-categories (underweight, normal weight, overweight, obese class I and II) it was evident, that normally weighted women tend toward amenorrhea as well at the beginning of LNG-IUD use as well after 4-5 years of use. In contrast to this, overweighed and obese women tend more often to amenorrhea at the end of use, but not at the beginning (72.7% and 55.6% vs. 25.0% and 0%). Women with a lower BMI were more often "very satisfied" concerning bleeding patterns, but not concerning the general satisfaction. Our study showed much evidence, that amenorrhea occurs more often in women with lower BMI contrary to women with a higher one-especially at the beginning of LNG- IUD use. Furthermore amenorrhea was mostly considered to be a positive menstrual change.
Article
To describe the success rate of and the quality of life after global endometrial ablation in an obese population. A follow-up survey was mailed to 72 women who had undergone global endometrial ablation. The survey included a menorrhagia-specific NovaSure endometrial ablation questionnaire. The mean follow-up time was 2.5years. Forty-four women (61%) responded, with a mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of 30.5. Overall, patients reported a decrease in missed social activities, in inability to perform activities of daily living, in missed work days, in bleeding tendencies, and in pain. The amenorrhea rate was 37%, and the success rate (those not requiring any further therapeutic treatment) was 86%. Patient satisfaction was 93%. Global endometrial ablation improved quality of life for obese women with menorrhagia and had a high rate of satisfaction, even for patients not achieving amenorrhea. Patients with a BMI of more than 34 showed a trend toward failure and a higher rate of hysterectomy.
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Although polycystic ovary syndrome (PCOS) is commonly cited as a risk factor for endometrial cancer, supporting epidemiological evidence is currently very limited. Our aim was to assess the associations between PCOS, PCOS symptoms, and risk of endometrial cancer in women aged less than 50 years. Data came from a national population-based case-control study in Australia. Cases with newly diagnosed histologically confirmed endometrial cancer were identified through treatment clinics and cancer registries Australia wide. Controls were randomly selected from the national electoral roll. Women were interviewed about their reproductive and medical history, including self-reported PCOS, and lifestyle. Current analyses were restricted to women aged under 50 (156 cases, 398 controls). We estimated odds ratios (OR) using logistic regression to adjust for confounding factors. Women with PCOS had a fourfold increased risk of endometrial cancer compared to women without PCOS (OR 4.0, 95% CI 1.7-9.3). This association was attenuated when additionally adjusted for body mass index (OR 2.2, 95% CI 0.9-5.7). Risk was slightly greater when restricted to Type I cancers. PCOS symptoms including hirsutism and very irregular periods were significantly associated with endometrial cancer risk. These data extend existing findings, including adjustment for confounders, suggesting PCOS is a risk factor for endometrial cancer.
Article
Weight loss after bariatric surgery often improves fertility but can pose substantial risks to maternal and fetal outcomes. Women who have undergone a bariatric surgical procedure are currently advised to delay conception for up to 2 years. We conducted a systematic review of the literature, from database (PubMed) inception through February 2009, to evaluate evidence on the safety and effectiveness of contraceptive use among women with a history of bariatric surgery. From 29 articles, five met review inclusion criteria. One prospective, noncomparative study reported 2 pregnancies among 9 (22%) oral contraceptive (OC) users following biliopancreatic diversion, and one descriptive study reported no pregnancies among an unidentified number of women taking OCs following laparoscopic adjustable gastric banding. Of two pharmacokinetic studies, one found lower plasma levels of norethisterone and levonorgestrel among women having had a jejunoileal bypass, as compared to nonoperated, normal-weight controls. The other study found no difference in plasma levels of D-norgestrel between women having a jejunoileal bypass of either 1:3 or 3:1 ratio between the length of jejunum and ileum left in continuity, but women with a 1:3 ratio had significantly higher plasma levels of D-norgestrel than extremely obese controls not operated upon. Evidence regarding OC effectiveness following a bariatric surgical procedure is quite limited, although no substantial decrease in effectiveness was identified from available studies. Evidence on failure rates for other contraceptive methods and evidence on safety for all contraceptive methods was not identified.
Article
Obesity has reached epidemic proportions around the world. Metabolic changes in obesity and greater body mass may lead to reduced effectiveness of hormonal contraceptives, such as the skin patch, vaginal ring, implants, and injectables. We systematically reviewed the evidence on the effectiveness of hormonal contraceptives among overweight and obese women. To examine the effectiveness of hormonal contraceptives in preventing unplanned pregnancies among women who are overweight or obese versus women of lower weight or body mass index (BMI). We searched MEDLINE, CENTRAL, POPLINE, EMBASE, ClinicalTrials.gov, and ICTRP. We also contacted investigators to identify other trials. All study designs were eligible. Any type of hormonal contraceptive could have been examined. The primary outcome was pregnancy. Overweight or obese women must have been identified by an analysis cutoff for weight or BMI (kg/m(2)). Data were abstracted by two authors; life-table rates were included where available. For dichotomous variables, we computed an odds ratio with 95% confidence interval. The main comparisons were between overweight or obese women and women of lower weight or BMI. We found 7 reports with data from 11 trials that included 39,531 women. One of three studies using BMI found a higher pregnancy risk for overweight or obese women. In the trial of two combination oral contraceptives, women with BMI >= 25 had greater pregnancy risk compared to those with BMI < 25 (OR 1.91; 95% CI 1.01 to 3.61). Among skin patch users, body weight was associated with pregnancy (reported P < 0.001) but BMI was not. Studies of a vaginal ring (never marketed) and a six-rod implant showed higher pregnancy rates for women weighing >= 70 kg versus those weighing < 70 kg (reported P values: 0.0013 and < 0.05, respectively). However, two implant studies showed no trend by body weight, and trials of an injectable had no pregnancies. Body weight addresses overall body size, while BMI generally reflects the amount of fat. Only one of three studies using BMI found a higher pregnancy risk for overweight women. The efficacy of implants and injectable contraceptives may be unaffected by body mass. The field could use trials of contraceptive methods with groups stratified by BMI. The current evidence on effectiveness by BMI is limited. However, the contraceptive methods examined here are still among the most effective when the recommended regimen is followed.
Article
Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) has not been studied in the extremely obese population (BMI >or=40 kg/m(2)). The purpose of this 26-week prospective experimental study was to determine incidence of ovulation and follicular development among women with Class 1, 2 and 3 obesity after receiving DMPA-SC. Five normal-weight, five Class 1-2 obese, and five Class 3 obese women received subcutaneous injections of 104 mg DMPA-SC at baseline and 12 weeks later. Weekly progesterone levels, bimonthly estradiol (E(2)), and monthly medroxyprogesterone acetate (MPA) levels were measured by immunoassay methods for a total of 26 weeks in each subject. Ovulation did not occur in any subject more than 1 week after the first injection. There was large intersubject and intrasubject variability in E(2) levels, and fluctuating E(2) levels were more frequent among obese women than normal-weight women. Median MPA levels remained above the level needed to prevent ovulation but, compared with normal-weight subjects, were lower among Class 1-2 obese and lowest among Class 3 obese subjects. Fluctuating E(2) levels reflective of follicular development occurred more often among Class 1, 2 and 3 obese women than normal-weight women after DMPA-SC injections. Median MPA levels were consistently lowest among Class 3 obese women but remained above the level needed to inhibit ovulation. Further studies should more fully address the pharmacokinetics of DMPA-SC in extremely obese women.
Article
This study was conducted to compare oral contraceptive (OC) pharmacokinetics (PK) in normal-weight [body mass index (BMI) 19.0-24.9] and obese (BMI 30.0-39.9) women. During the third week of the third cycle of OC use, we admitted 15 normal-weight and 15 obese women for collection of 12 venous specimens over 24 h. Using radioimmunoassay techniques, we measured levels of ethinyl estradiol (EE) and levonorgestrel (LNG). During the same cycle, women underwent twice-weekly sonography to assess ovarian follicular development and blood draws to measure endogenous estradiol (E2) and progesterone levels. Obese women had a lower area under the curve (AUC; 1077.2 vs. 1413.7 pg*h/mL) and lower maximum values (85.7 vs. 129.5 pg/mL) for EE than normal-weight women (p=.04 and <0.01, respectively); EE trough levels were similar between BMI groups. The similar, but smaller, differences in their LNG levels for AUC and maximum values (C(max)) were not statistically significant. While peak values differed somewhat, the LNG trough levels were similar for obese and normal-weight women (2.6 and 2.5 ng/mL, respectively). Women with greater EE AUC had smaller follicular diameters (p=.05) and lower E2 levels (p=.04). While follicular diameters tended to be larger among obese women, these differences were not statistically significant. OC hormone peak levels are lower among obese women compared to normal-weight women, but their trough levels are similar. In this small study, the observed PK differences did not translate into more ovarian follicular activity among obese OC users.
Article
The objective of this study was to perform a systematic review of the literature to determine whether there is an association between polycystic ovary syndrome (PCOS) and gynaecological malignancy. Medline and Embase databases (1968-2008) were searched to identify publications on the association between PCOS and gynaecological cancers including breast cancer. Studies were selected that examined the association between PCOS and all types of gynaecological malignancies. A total of 19 studies exploring the association between PCOS and breast, endometrial and ovarian cancer were identified. Of these, only eight could be included after review. The data showed variability in the definition of PCOS. A meta-analysis of the data suggests that women with PCOS are more likely to develop cancer of the endometrium (OR 2.70, 95% CI 1.00-7.29) and ovarian cancer (OR 2.52, 95% CI 1.08-5.89) but not breast cancer (OR 0.88, 95% CI 0.44-1.77). Women with PCOS appear to be three times more likely to develop endometrial cancer but are not at increased risk of breast cancer. There is insufficient evidence to implicate PCOS in the development of vaginal, vulval, cervical or ovarian cancers. The paucity of studies investigating the association between PCOS and gynaecological cancers is likely to affect the reliability of the conclusions.
Article
The objective of this systematic review is to determine whether obese women who use progestogen-only contraceptives are more likely to experience weight gain or serious adverse events as compared to nonobese users. We searched PubMed for all articles (in all languages) published in peer-reviewed journals from database inception through October 2008, for evidence relevant to obesity and progestogen-only contraceptives. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. From 579 articles, we identified nine studies fitting our selection criteria. Evidence from five studies suggests that among adult women, baseline weight or body mass index is not associated with weight gain among depot medroxyprogesterone acetate (DMPA) users (Level II-2, Fair). Evidence from three studies suggests that among adolescent women, overweight or obese DMPA users may gain more weight than normal weight DMPA users or overweight/obese nonusers (Level II-2, Fair). Evidence from one small study of Norplant users showed no differences in weight gain by baseline weight (Level II-3, Poor). We did not identify studies of other progestogen-only contraceptive methods that examined weight change by baseline weight, nor did we identify studies that reported on any serious adverse events by baseline weight. Adolescent DMPA users who are obese may gain more weight than normal weight users. This observation was not seen in adult DMPA users or adolescent Norplant users.
Article
The purpose of this study was to assess the use-effectiveness of oral contraceptives (OCs) in Europe according to body mass index (BMI), weight, age, and other factors. In a planned secondary analysis, we used data from the European Active Surveillance Study on Oral Contraceptives, which was a prospective active cohort surveillance study of 59,510 OC users, to assess the effectiveness of OCs overall and by BMI, weight, age, duration of use, ethinylestradiol dose, regimen type, starting/switching status, and parity. Self-reported unplanned pregnancies during OC use were confirmed by interview. An analysis of OC effectiveness (112,659 women-years of exposure and 545 unplanned pregnancies) found little variation in effectiveness by BMI/weight. Failure rates decreased after 30 years of age and with an increasing duration of use. OC users in Europe reported high contraceptive effectiveness with "typical use." Failure rates decreased with age and duration of use. BMI and weight had little, if any, influence on effectiveness.
Article
There is a very high prevalence of obese women in the infertile population and many studies have highlighted the link between obesity and infertility. The aim of this study was to evaluate the prevalence of oligomenorrhea in uncomplicated obesity, and to examine whether this menstrual alteration is associated with anthropometric, hormonal, and metabolic parameters. This is a cross-sectional study of 266 overweight and obese body mass index (BMI) > or =25.0 kg x m(-2)] women, all having apparent normal fertility. Measurements included BMI, central fat accumulation (evaluated by waist circumference), blood pressure levels, and fasting insulin, glucose, and lipid (triglycerides, total and HDL-cholesterol) serum concentrations, and insulin resistance [estimated by (homeostasis model assessment) HOMAIR] during the early follicular phase (days 2-5 of the menstrual cycle). One hundred and seventy-one (64.3%) of 266 women had normal menstrual cycles, 57 (21.4%) had oligomenorrhea, and 38 (14.3%) had hypermenorrhea and/or polimenorrhea. Women with oligomenorrhea had higher waist circumference, BMI, HOMAIR, and insulin levels than women with normal menstrual cycles. When association among oligomenorrhea and other variables (waist circumference, BMI, insulin and HOMAIR) was evaluated by logistic regression, and odds ratio was calculated per unit of SD increase, only waist circumference maintained a significant relationship with oligomenorrhea. This study shows that more than 20% of women with simple obesity have oligomenorrhea, and suggests that central fat accumulation seems to have a possible direct role in this menstrual alteration, independently of hyperinsulinemia and/or insulin resistance.
Article
Oral contraceptive pills (OCPs) are the most popular form of reversible contraception in the United States. Most commonly used OCPs contain a combination of estrogen and progestin. However the efficacy of OCPs is due primarily to the suppression of ovulation that results from the dose of progestin. Changes in the absorption volume of distribution metabolism or excretion of a medication may change its pharmacologic potency. For some medications the volume of distribution for a given dose in an obese individual is greater than the volume of distribution for a thinner individual. In addition in obese patients drugs that undergo Phase II metabolism (or a conjugation reaction with glucuronic acid sulfonates glutathione or amino acids) tend to be metabolized more rapidly thus shortening their duration of action. Increasing body weight has been shown to change rates of estradiol metabolism in young women. Time to reach steady-state levels of levonorgestrel after ingestion appears to be twice as long among obese women compared with women of normal weight; therefore the interval until hypothalamic-pituitary-ovarian activity is suppressed may be lengthened placing obese women at higher risk for ovulation. Our goal was to summarize and evaluate the existing literature addressing the question of whether women with increased weight or body mass index (BMI) have an increased risk of OCP failure compared with normal weight women. This is an issue of public health importance both because obesity is reaching epidemic proportions in the United States and because pregnancy complications are more likely to occur among obese women than thinner women. (excerpt)
Article
There is a close relationship between the amount of estogen and progesterone secreted by the ovary from puberty to menopause and the development of hyperplastic endometrium of all types and finally endometrial cancer. The endogenous endocrine pattern reflects progesterone deficiency (corpus luteum deficiency). Such deficiency can also develop when treatment with exogenous estrogen and progestogen is done and a deficiency of the progestogen in comparison to the used estrogen is induced in pre- and postmenopausal women. This risk is particular accentuated in the climacteric female when the endocrine milieu was unfavorable in the years before (menstrual cycle disorders, PCOS, obesity, no full-term pregnancy, no breast feeding, etc.).
Article
Historical data from 26 638 20-to 40-year women were used to study the association between obesity and menstrual abnormalities including evidence of infertility. It was found that women with evidence of anovulatory cycles, ie, irregular cycles greater than 36 days, and hirsutism, were more than 30 lb (13.6 kg) heavier than women with no menstrual abnormalities after adjusting for height and age. The percentage of women with evidence of anovulatory cycles was 2.6 per cent for women less than 20 per cent overweight, 4.0 per cent for women 20-49 per cent overweight, 5.8 per cent for women 50-74 per cent overweight., and 8.4 per cent for women more than 74 per cent overweight Women with a single menstrual abnormality including cycles greater than 36 days, irregular cycles, virile hair growth with facial hair, or heavy flow were also significantly heavier than women with normal values for these factors. A longer duration of obesity was associated with facial hair. Another analysis found that teenage obesity was greater for never-pregnant married women than for previously pregnant married women and for women having ovarian surgery for polycystic ovaries than for women having ovarian surgery for other reasons. This also supports an association of obesity with anovulatory cycles. These findings showing evidence of abnormal ovulation, menstrual abnormalities and excess hair growth in obese women may be explained by the recent studies of others demonstrating an association between obesity and hormonal imbalances.
Article
To determine the advantages and disadvantages of endometrial resection and abdominal hysterectomy for the surgical treatment of women with menorrhagia. Randomised study of two treatment groups with a minimum follow up of nine months. Royal Berkshire Hospital, Reading. 51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy. Endometrial resection or abdominal hysterectomy (according to randomisation). Endometrial resections were performed by an experienced hysteroscopic surgeon; hysterectomies were performed by two other gynaecological surgeons. Length of operating time, hospitalisation, recovery; cost of surgery; short term results of endometrial resection. Operating time was shorter for endometrial resection (median 30 (range 20-47) minutes) than for hysterectomy (50 (39-74) minutes). The hospital stay for endometrial resection (median 1 (range 1-3) days) was less than for hysterectomy (7 (5-12) days). Recovery after endometrial resection (median 16 (range 5-62) days) was shorter than after hysterectomy (58 (11-125) days). The cost was 407 pounds for endometrial resection and 1270 pounds for abdominal hysterectomy. Four women (16%) who did not have an acceptable improvement in symptoms after endometrial resection had repeat resections. No woman has required hysterectomy during a mean follow up of one year. For women with menorrhagia who have no pelvic pathology endometrial resection is a useful alternative to abdominal hysterectomy, with many short term benefits. Larger numbers and a longer follow up are needed to estimate the incidence of complications and the long term efficacy of endometrial resection.
Article
The association between weight, physical activity, and stress and variation in the length of the menstrual cycle was prospectively examined in 166 college women, aged 17-19 years, who kept menstrual diaries during their freshman year. The unadjusted probability of a menstrual cycle being longer than 43 days was 5%. Women with a history of long cycles were more likely to have a long cycle during the study (odds ratio (OR) = 4.3). Stressors, characterized by situations which create a demand for performance or require adjustments to new demands, also increased the risk of a long cycle. Odds ratios for gain events and for coping with multiple performance demands (2 vs. 0) were 1.9. Starting college increased the risk of long cycles (OR = 2.3) regardless of whether a woman had left home. Moderate exercise minimally increased the probability of a long cycle (OR = 1.1, 75th vs. 50th percentiles). Change in weight (OR = 1.9) and being overweight (OR = 1.2, 15% above standard weight for height) were independently associated with the probability of long cycles. When 17- to 43-day cycles were evaluated, a history of long cycles lengthened expected cycle length by 1.42 days, while dieting, living on campus, and starting college tended to shorten expected length by 1.38, 0.90, and 0.64 days, respectively. Further investigation of the biologic mechanisms that mediate the stress effect is warranted.
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In 20 women with menorrhagia (greater than 80 ml blood loss per menstrual period) a levonorgestrel-releasing intrauterine device (Lng-IUCD) was inserted. Menstrual blood loss (MBL) was measured in two consecutive cycles before the device was inserted and after 3, 6 and 12 months of use. MBL was significantly reduced after 3 months (86%) and after 12 months the reduction was 97%. There was a significant increase (P less than 0.001) in serum ferritin during the first year of Lng-IUCD use. The Lng-IUCD seems to be an important alternative to oral medication and to hysterectomy in the treatment of menorrhagia.
Article
Factors influencing sex-hormone binding globulin (SHBG) concentrations in obesity are poorly understood. Preliminary observations suggest that dietary lipids may be involved and there are data confirming a direct inhibiting effect of insulin. Since only some obese subjects show lowered SHBG levels, we performed this study with the aim of defining obese women with low SHBG (LSO) (2 SD above normal values) in comparison with those presenting normal globulin concentrations (NSO). These groups were selected from a larger group of obese women with a history of normal menses and aged less than 40 years. An age-matched group of normal weight healthy women served as controls. Both LSO and NSO had similar body mass index and percentage body fat, but the waist to hip girth ratio (WHR), an index of body fat distribution, was significantly higher in LSO (0.88 +/- 0.04) than in NSO (0.81 +/- 0.09; P less than 0.05). Gonadotropin and androgen concentrations were similar in both groups, whereas estrone (E1) levels were higher in LSO (32.8 +/- 15.8 pg/ml) than in NSO (19.4 +/- 6.2 pg/ml; P less than 0.05; controls: 23.5 +/- 7.8 pg/ml; P less than 0.05). Moreover, compared to NSO, LSO women had significantly higher glucose-stimulated insulin and C-peptide levels. Partial regression analysis revealed significant correlation coefficients between SHBG, stimulated insulin values (r = -0.38; P less than 0.05) and WHR (r = 0.40; P less than 0.005). Therefore, compared to NSO, LSO women have distinctive clinical and endocrine characteristics, namely more pronounced hyperinsulinemia, higher E1 concentrations and a central type body fat distribution.
Article
Excess body fat has been clearly associated with an increased risk of oligo-ovulation and endometrial/breast carcinoma. The connection has been assumed to lie within derangements of the metabolic/endocrine compartments, particularly of estrogens and androgens. To differentiate the effect of obesity from its related disease process, an attempt has been made to define the reproductive-endocrinologic alterations encountered in otherwise asymptomatic obese women. Androgen metabolism is accelerated in obesity. It is not clear whether the increased clearance precedes or follows the accelerated production of androgens. A servocontrol mechanism appears to be operative in these asymptomatic individuals, maintaining plasma steroid levels normal. The unbound fraction of T may be somewhat increased in overweight women with predominantly upper body fat deposition. The increased clearance of androgen may arise from an obesity-related depression in SHBG concentration (e.g., for T, E2, delta 5-diol, etc.). Adipose tissue, by virtue of the lipid solubility of most of these steroids, concentrates androgens, estrogens, and progesterone. This steroid sequestration not only contributes to the obesity-related increase in androgen clearance but also leads to an extremely enlarged total body steroid pool. Fat tissue sequestration also increases the concentration of androgens in the vicinity of adipose stromal cells, possibly encouraging their aromatization. Adipose tissue also has a moderate degree of 17-hydroxysteroid dehydrogenase activity, which appears to stimulate the conversion of A to T. Finally, alterations in peripheral and hepatic conjugation and an accelerated urinary excretion may contribute to the elevated clearance of androgens. The accelerated PR of androgens may simply result as compensation for the elevated MCR in obesity. Nonetheless, evidence of alteration(s) in adrenocortical steroidogenesis has been presented suggesting a selective obesity-related enhancement in adrenal androgen secretion. These remain to be confirmed. Nonetheless, adrenocortical abnormalities may arise secondary to the influence of other circulating and intra-adrenal factors, including insulin, prolactin, estrogens, and androgens. It is not known whether the accelerated androgen metabolism or the aberrant adrenal steroidogenesis improve with weight reduction. Excess body fat increases androgen aromatization which, together with an obesity-related decrease in SHBG, is associated with mildly elevated levels of E1 and free E2 in postmenopausal women. Although premenopausal obese individuals have the same tendency, the far greater ovarian estrogen secretion overshadows any differences. The bulk of aromatization activity in fat lies in the stromal comportment. The major substrate for peripheral estrogen production is A. Testosterone also contributes to the estrogen pool via its conversion to E2.(ABSTRACT TRUNCATED AT 400 WORDS)
Article
To examine hormonal status in obese, gynecologically normal women we studied 25 regularly menstruating, massively obese (mean weight, 120 kg) women participating in a weight reduction program and 25 age-matched normal weight (mean weight, 60 kg) women. Serum 17 beta-estradiol (E2), estrone (E1), androstenedione (A), dehydroepiandrosterone sulfate, testosterone, LH, FSH, PRL, and cortisol concentrations were measured during the follicular phase of the menstrual cycle. Waist to hip ratio and abdominal fat cell size were measured at the beginning of the study. The serum levels of E2 (P less than 0.04) as well as those of A, SHBG, and LH (P less than 0.002) were lower in the obese group. Consequently, the testosterone to SHBG ratio and the E1 to A ratio were higher and the LH to FSH ratio was lower in this group. Waist to hip ratio did not correlate with the levels of circulating hormones or SHBG, but an inverse correlation was found between abdominal fat cell size and A as well as the LH to FSH ratio in the nonhirsute women of the obese group. Subsequent to moderate weight reduction (13.2 kg), serum A and E1 levels (P less than 0.01) increased, and serum cortisol levels decreased (P less than 0.001). Thus, massive obesity is associated with abnormalities in hormonal balance in gynecologically symptomless women, there being an association between E1, E2, A, LH, cortisol, and relative weight and/or ab