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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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... Growing evidence supports a multifactorial etiology of infertility, including genetic factors, 1 environmental chemical exposures [2][3][4][5][6][7] and obesity. [8][9][10][11][12] Obesity and dyslipidemia are highly prevalent in US women (39.7% 13 and 20%, 14 respectively) and both are associated with a higher risk of reproductive health disorders, such as amenorrhea, 11 lower conception and implantation rates, 12 delayed puberty, ovarian endocrinopathies, poor oocyte quality, and higher pregnancy complications. [8][9][10] Women with the polycystic ovarian syndrome (PCOS) also have higher triglycerides (TAGs) and low high-density lipoprotein (HDL), [15][16][17][18] which are both negatively associated with implantation rates, clinical pregnancy rates, and live birth rates. ...
... Growing evidence supports a multifactorial etiology of infertility, including genetic factors, 1 environmental chemical exposures [2][3][4][5][6][7] and obesity. [8][9][10][11][12] Obesity and dyslipidemia are highly prevalent in US women (39.7% 13 and 20%, 14 respectively) and both are associated with a higher risk of reproductive health disorders, such as amenorrhea, 11 lower conception and implantation rates, 12 delayed puberty, ovarian endocrinopathies, poor oocyte quality, and higher pregnancy complications. [8][9][10] Women with the polycystic ovarian syndrome (PCOS) also have higher triglycerides (TAGs) and low high-density lipoprotein (HDL), [15][16][17][18] which are both negatively associated with implantation rates, clinical pregnancy rates, and live birth rates. ...
... 97 Nevertheless, higher lipid storage in the form of lipid droplets can progressively lead to chronic tissue injury via these cellular stress responses and eventually fibrosis or cancer, such as that reported in fatty liver. 119,120 Although associations between systemic dyslipidemia and infertility have been reported, [8][9][10][11][12]121,122 the potential clinical consequences of higher lipid droplet accumulation in ovarian cells remain virtually unexplored. PCA of cytokine levels indicates that TBT-exposed theca cells have a differential cytokine signature in comparison with control and DBT-exposed cells. ...
Article
Background: Exposure to obesogenic chemicals has been reported to result in enhanced adipogenesis, higher adipose tissue accumulation, and reduced ovarian hormonal synthesis and follicular function. We have reported that organotins [tributyltin (TBT) and triphenyltin (TPT)] dysregulate cholesterol trafficking in ovarian theca cells, but, whether organotins also exert lipogenic effects on ovarian cells remains unexplored. Objective: We investigated if environmentally relevant exposures to organotins [TBT, TPT, or dibutyltin (DBT)] induce lipid dysregulation in ovarian theca cells and the role of the liver X receptor (LXR) in this effect. We also tested the effect of TBT on oocyte maturation and neutral lipid accumulation, and lipid-related transcript expression in cumulus cells and preimplantation embryos. Methods: Primary theca cell cultures derived from human and ovine ovaries were exposed to TBT, TPT, or DBT (1, 10, or 50 ng/ml). The effect of these chemical exposures on neutral lipid accumulation, lipid abundance and composition, lipid homeostasis-related gene expression, and cytokine secretion was evaluated using liquid chromatography-mass spectrometry (LC-MS), inhibitor-based methods, cytokine secretion, and lipid ontology analyses. We also exposed murine cumulus-oocyte complexes to TBT and evaluated oocyte maturation, embryo development, and lipid homeostasis-related mRNA expression in cumulus cells and blastocysts. Results: Exposure to TBT resulted in higher intracellular neutral lipids in human and ovine primary theca cells. In ovine theca cells, this effect was dose-dependent, independent of cell stage, and partially mediated by LXR. DBT and TPT resulted in higher intracellular neutral lipids but to a lesser extent in comparison with TBT. More than 140 lipids and 9 cytokines were dysregulated in TBT-exposed human theca cells. Expression of genes involved in lipogenesis and fatty acid synthesis were higher in theca cells, as well as in cumulus cells and blastocysts exposed to TBT. However, TBT did not impact the rates of oocyte maturation or blastocyst development. Discussion: TBT induced dyslipidemia in primary human and ovine theca cells, which may be responsible for some of the TBT-induced fertility dysregulations reported in rodent models of TBT exposure. https://doi.org/10.1289/EHP13955.
... Binge eating and anorexia in particular were associated with secondary amenorrhea [31][32][33]. Individuals with a BMI above the range of 18.5 to 24.9 are more prone to AUB [28,30,[34][35][36][37]. However, the type of dysfunction present is quite variable. ...
... However, the type of dysfunction present is quite variable. Individuals with a BMI from 25 to 25.9 have a heavier menstrual blood flow [35,36] and more irregular periods than those who have a BMI from 18.5 to 24.9 [36,37]. For example, a prospective study of college-aged menstruators found overweight students were at an increased risk of having a cycle longer than 43 days [37]. ...
... Individuals with a BMI from 25 to 25.9 have a heavier menstrual blood flow [35,36] and more irregular periods than those who have a BMI from 18.5 to 24.9 [36,37]. For example, a prospective study of college-aged menstruators found overweight students were at an increased risk of having a cycle longer than 43 days [37]. Additional studies report menstrual irregularity, particularly amenorrhea, among individuals with a history of significant weight loss or are underweight (BMI < 18.5) [28,30]. ...
Article
The modifiable and non-modifiable determinants and the currently available methods of assessment of menstrual blood flow will be discussed, with the goal of helping healthcare providers, researchers, and those interested in public health. Several factors can impact menstruation. The determinants include modifiable factors such as smoking, nutrition, exercise, stress, weight fluctuation, and benign gynecologic diseases, and non-modifiable factors such as age, race, and the individual’s genes. The intertwined dynamic among these determinants needs more critical attention. Currently, the methods for the assessment of menstruation all have advantages and disadvantages, often with a tradeoff between practicality and accuracy. Considered by many as the fifth vital, menstruation provides a window to an individual’s general health. The discussion of its determinants and assessment can be more appropriate for individual contexts, especially from a public health perspective as it can improve the reproductive health of the population.
... 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 . ...
Article
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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).
... Obesity is an increasingly common public health problem that has been shown to reduce quality of life and impair sexual functionality [5,7]. Furthermore, obese women often present with oligomenorrhea, amenorrhea, or irregular menstrual periods [17]. It was reported that FSFI scores were decreased in patients with irregular menstruation, regardless of age, BMI, socioeconomic status, or parity [12]. ...
... After successful sleeve gastrectomy surgery, improvement in menstrual and ovarian function along with improved biomarkers of metabolic syndrome has been previously reported [6,9,17]. Pilone et al. observed an improvement in the menstrual cycle and resolution of dysmenorrhea after LSG [9]. ...
Article
Full-text available
Purpose Obesity is a systemic condition that is increasingly common. Obesity negatively affects sexual function and menstrual regularity. Therefore, losing excess weight is important for women's sexual and menstrual health. Methods The change in body mass index (BMI) and and excess weight loss (EWL) of sexually active female patients who underwent laparoscopic sleeve gastrectomy (LSG) were evaluated by a general surgeon. The preoperative and postoperative periods were compared by a gynecologist using the survey method menstrual patterns, dysmenorrhea complaints, if any, and sexual function with the Female Sexual Function Scale (FSFI). Results The study included 55 patients with a mean ± standard deviation BMI on the day of the operation of 45.32 ± 5.82 kg/m2. In the first postoperative year, the mean BMI significantly reduced to 27.88 ± 1.99 (p < 0.001). The mean percentage of EWL at the end of 1 year was 73.09 ± 19.74 after LSG. The median (range) preoperative FSFI score of the patients was 26.30 (22.70–27.70). One year after LSG, the median FSFI score significantly improved to 34.50 (30.20–35.30) (p < 0.001). Compared to the period before surgery, the frequency of sexual intercourse increased from two-to-three times a week (p < 0.001). Conclusion Women's sexual desires are a fundamental human right and contribute to female well-being. Thus, it is important to treat sexual dysfunction. The results of the present study demonstrate a significant improvement in sexual dysfunctions after LSG. LSG was an effective procedure that may be recommended to obese women with sexual dysfunction and menstrual problems. Graphical abstract
... У тучных женщин также снижен уровень глобулина, связывающего половые гормоны, что вызывает повышение уровня циркулирующего или свободного тестостерона [33]. Кроме того, повышенный уровень инсулина стимулирует выработку андрогенов стромальной тканью яичников [34]. Эти изменения концентрации гонадных стероидных гормонов при ожирении вызывают нарушение нормальной овуляции и нарушения менструального цикла, в том числе нерегулярные менструальные кровотечения, олигоменорею и аменорею [34]. ...
... Кроме того, повышенный уровень инсулина стимулирует выработку андрогенов стромальной тканью яичников [34]. Эти изменения концентрации гонадных стероидных гормонов при ожирении вызывают нарушение нормальной овуляции и нарушения менструального цикла, в том числе нерегулярные менструальные кровотечения, олигоменорею и аменорею [34]. ...
Article
Amenorrhea is the absence or abnormal cessation of the menstrual cycle. Functional hypothalamic amenorrhea (FHA) is one of the most common and least studied forms of secondary (hypothalamic) amenorrhea that occurs after adaptation failure in response to mental, social and metabolic irritants. At there are no common threshold values of potential irritants and markers of efficacy for female patioents with FHA. Methods of diagnostics, treatment and prevention of FHA stay still not personalized, but empirical. The most promising solution of present problem is combination of nutritive and mental correction among females with FHA. Also, the most promising step is searching and studying of omics (genomic, epigenomic, transcriptomic, proteomic and metabolomic) markers of hypothalamic–hypophysial-gonadal axis disruption. This review shows the association between amenorrhea and stress, changes in nutrition or weight, excessive physical activity, and the COVID-19 pandemic. The literature was searched in Russian and English languages in eLibrary, MEDLINE, and Scopus databases mainly for the last decade. Due to the insufficient study of the chosen topic, sources dating back to the 1990s were also selected.
... 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). ...
Article
Full-text available
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. ...
Article
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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.
... Непредсказуемые кровотечения могут быть результатом несоблюдения режима приема орального контрацептивного средства, взаимодействия его с другими препаратами или появлением интеркуррентных состояний, таких как рвота и диарея. Курение и высокий индекс массы тела увеличивают вероятность нерегулярных кровотечений [35]. Участницы нашего исследования не сообщали о несоблюдении режима приема таблеток, не применяли какие-либо лекарственные препараты, потенциально влияющие на характеристики кровотечений, острых нарушений со стороны желудочно-кишечного тракта у них не отмечалось. ...
Article
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Background. An unfavorable bleeding pattern is a common reason for refusing to continue hormonal contraception. Aim. To evaluate the characteristics of uterine bleeding when using a new combined oral contraceptive (COC) containing estetrol and drospirenone (Esteretta®). Materials and methods. A multicenter observational study included 1402 females aged 18–49 who received Esteretta® for 6 cycles. The frequency, duration, and severity of withdrawal bleeding, as well as the frequency of unpredictable bleeding, were assessed. Results. The rate of regular withdrawal bleeding was 100%. The proportion of women with heavy menstruation/withdrawal bleeding decreased from 29.6 to 10.07% (p0.0001). The duration of regular withdrawal bleeding was significantly reduced (p=0.008). The incidence of unpredictable bleeding during COC use decreased from 4.57 to 3.29% (p=0.05). Satisfactory cycle control was observed in 87.43% of women. 2.5% of participants refused to continue using COCs. Conclusion. Esteretta® provides a high rate of regular withdrawal bleeding and a low rate of unpredictable bleeding. Given the optimal safety profile, this drug may be the first choice for contraception in sexually active women who are not planning a pregnancy.
... Sex steroids modulate several neurotransmitters, such as the cholinergic, serotonergic, and dopaminergic systems, and changes in these hormones influence emotional processing and mood (Sundström-Poromaa 2018). On the other hand, psychosocial symptoms may cause disturbances in the steroid hormones and may be disruptions of the normal menstrual cycle, such as irregular menstrual bleeding, oligomenorrhea, amenorrhea, and likely anovulatory cycles (Donoghue et al. 2000;Seif et al. 2015;Whitaker and Critchley 2016). ...
Article
Full-text available
Stress, infections, and psychological and social well-being can affect the reproductive system. Activation of the hypothalamic-pituitary-adrenal axis can disrupt ovarian cyclicity. Estrogens can modulate stress responsiveness and mood. Thus, understanding this interaction and how it modulates the menstrual cycle is crucial for women’s reproductive health. Purpose The objective of this study was to analyze the influence of a stressor, a period of the Covid-19 pandemic when there were no vaccines available yet, on the psychological state of women aged 18 to 45 years; as well as the influence of mental health on the menstrual cycle, considering the influence of age and hormonal contraceptives. Method Online questionnaire using the Google Forms platform was used. Results There is a high prevalence of the onset of new psychosocial symptoms. Moreover, most women reported some type of change in their menstrual cycles. The women who were using hormonal contraceptives demonstrated a higher frequency of spotting and menstrual color alterations, while women without hormonal contraceptives demonstrated a higher frequency of cycle duration and menstrual odor alterations. Women without hormonal contraceptives were more susceptible to the development of psychosocial symptoms. Younger adult women were more affected by menstrual changes and psychosocial symptoms. Close to 90% of women who reported several psychosocial symptoms had changes in their menstrual cycles. Conclusion These data suggest the impact of stressors, such as a period of the pandemic, on mental health and menstrual cycles, and younger adult women can be more susceptible. This reflects the relationship between mental and reproductive health.
... 30 As the aromatization of androgens to steroids increases by the increase in adipose tissue, it leads to changes in globin hormone levels binding to sex hormones, which result in impaired regulation of the menstrual cycle. 31 In adults, the association of obesity, through anthropometric and body adiposity variables, with menstrual abnormalities is evident. Women with frequent and infrequent cycles have significantly higher mean values of WC, BMI, WHtR, and WHR, which determines general and abdominal obesity. ...
Article
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Objective The present study aims to understand the prevalence of certain menstrual abnormalities among the adolescents and adults of the Poumai tribe of Manipur and explore the association of anthropometric variables and body adiposity with menstrual disorders. Materials and Methods The study is a cross-sectional study conducted on 1,008 Poumai women among the reproductive age groups, consisting of 496 adolescents and 512 adults. Menstrual history was collected from each participant, and menstrual abnormalities in the menstrual frequency and flow volume were identified per the International Federation of Gynecology and Obstetrics classification. Relative indices of the measured anthropometric variables defined body adiposity. Descriptive statistics and tests of significance were calculated. Regression odd ratio analysis was also conducted to infer the odds ratio risk of menstrual abnormalities. Results The overall prevalence of menstrual frequent and infrequent is 8.2% and 19.6%, respectively, where frequent is more prevalent in adolescents and infrequent in adults. Note that 15.4% and 5.6% of the women have a heavy and light flow, while comparatively, adults have a higher prevalence of heavy and light flow than adolescents. Anthropometric variables are associated with menstrual frequency abnormalities among adolescents, while these variables are associated with menstrual frequency and flow volume abnormalities in adults. Higher body adiposity has a higher odd ratio to the studied menstrual abnormalities, significantly with light menstrual flow. Conclusion Disparity observed in the menstrual abnormalities among adolescents and adults could reflect hormonal changes. The association of obesity with menstrual abnormalities highlights the concern of weight management that can lead to healthy reproductive health in women.
... Формирование предрасположенности к негативным реакциям на прогестагенную нагрузку может возникать под влиянием внешних факторов. Известно, что частоту неплановых кровотечений у пользовательниц КОК повышают курение и избыточный вес [13,14]. Механизм, связываю щий ожирение с аномальным паттерном кровотечений, сложен, и, поскольку ожирение само по себе ассоциировано с множеством рисков приема КОК, выбор контрацепции в данном случае вряд ли будет определяться возможностью плохого контроля цикла. ...
Article
Hormonal contraception is widely used to prevent unintended pregnancies and is represented by a large number of drugs that allow to personalize the choice of contraceptives for each woman. Combined oral contraceptive (COC) variants include not only drugs that differ in qualitative composition, but also modifications of the dosage regimen. Among the non-trivial regimens are triphasic active ingredient dosing that enables to achieve a reduction in progestogen burden while maintaining contraceptive efficacy. This approach is important in prescribing COCs to women who have previously experienced or may potentially experience adverse reactions to progestogens. Identification of target groups of women predisposed to progestogen-dependent side effects helps to correctly prescribe COCs and improve adherence to the contraceptive method. Thus, changes in bleeding characteristics during the use of hormonal contraceptives may lead to refusal of COCs. With the exception of patients who are prescribed COCs for additional therapeutic purposes to control the menstrual cycle rhythmicity and intensity, women expect that they keep the usual pattern of their cycle and react negatively to any changes or deviations from the reference ranges. Meanwhile, the bleeding profile during the use of hormonal contraceptives can change significantly. Characteristics such as the intensity and predictability of uterine bleeding are important for the assessment of the effect of a contraceptive on uterine bleeding. This analytical review presents groups of young women for whom initial use of triphasic COCs may be the best choice.
... These hormonal alterations can cause ovulatory dysfunction, which is infrequent ovulation that prolongs the menstrual cycle proliferative phase. This increased exposure to unopposed oestrogen may promote endometrial overgrowth and increase the chance of monthly irregularities (18). Furthermore, vitamins might cause excessive bleeding. ...
Article
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Background: The COVID-19 pandemic has had effects beyond the respiratory system, impacting health and quality of life. Stress-related to the pandemic has led to temporary menstrual pattern changes in around one-third of women. These changes, likely driven by stress and anxiety, can result in problematic heavy bleeding, causing anemia and negatively affecting women's well-being. This also places a substantial socioeconomic burden on individuals, families, healthcare, and society. Objectives: This study examined the impact of COVID-19 infection on the hormone levels (estradiol, prolactin, follicle-stimulating hormone, and luteinizing hormone) and heavy menstrual bleeding in Iraqi premenopausal women infected for at least four months. Patients and Methods: This case-control study was conducted from November 2021 to April 2022, involving 100 married women aged 18 to 40. Participants were divided into two groups: 50 women with heavy bleeding post-COVID-19 infection (infection duration of at least four months) and 50 non-infected women. Results: Comparing the Mean ± SD of the two groups, showed that the LH levels were statistically highly significant in women who suffered heavy bleeding post-COVID-19 infection compared to non-COVID-19 women, with a p-value of 0.000. There was no statistically significant difference in FSH levels between the two groups. The PRL levels were significantly higher for women who suffered substantial bleeding following COVID-19 infection compared to non-COVID-19 women, with a p-value of 0.003. Moreover, The E2 was significantly higher in women who suffered excessive bleeding following COVID-19 infection than non-infected women. Conclusion: This study suggests that COVID-19 may temporarily disrupt menstrual patterns, possibly due to stress and anxiety affecting the hypothalamus-pituitary-ovary axis. This disruption can manifest as elevated levels of gonad hormones (LH, PRL, and E2) and, in some cases, lead to heavy bleeding after a coronavirus infection. Received Oct. 2022 Accepted Oct. 2023 Published Jan. 2024
... En este estudio se comparó el valor del índice de masa corporal y del índice triponderal en pacientes con un diagnóstico de sangrado uterino anormal agudo y crónico, sin lograr obtener diferencia significativa en los valores y sin poder establecer una asociación entre la presencia de sobrepeso y obesidad determinada por IMT con la presencia de SUA agudo o crónico; así como para el valor del IMC en presencia de SUA agudo o crónico, por lo que discrepa con lo reportado en la literatura ,como lo demuestran Nouri et al. 22 Se estudiaron 292 mujeres con una mediana de edad de 38.5 (IRC 33-41), y 116 (39.86%) tenían sobrepeso y 129 (44.33%) obesidad; fue posible identificar una mayor prevalencia de pacientes con alteraciones ponderales, lo que representa un factor de riesgo para presentar sangrado http://revistamedica.imss.gob.mx/ uterino anormal, como lo describen en su publicación Reavey et al. 23 y Zhou et al. 24 Al analizar el valor del IMC con la presencia de sangrado uterino en sus tiempos de evolución agudo y crónico, no se encontró diferencia significativa al comparar los grupos de pacientes en normopeso (p =0.44), sobrepeso (p = 0.46) y obesidad (p = 0.81), lo que contrasta en estudios previos realizados en los que se observan alteraciones de sangrado uterino al presentar obesidad, como lo reportado por Itriyeva et al., Seif et al. y Reavey et al. 25,26,27 Al analizar el valor del índice triponderal con la presencia de sangrado uterino en sus presentaciones de tiempo de evolución agudo o crónico, no fue posible encontrar diferencia significativa ante la presencia de sobrepeso (p = 0.98) y obesidad (p = 0.93), y no encontramos hallazgos previos en la literatura para este análisis estadístico, ya que si bien el IMT en la actualidad se reconoce como un parámetro para estimar la adiposidad corporal, y actualmente se estudia su asociación con otras patologías asociadas a la obesidad, 28 no se había utilizado el índice triponderal como predictor de presentación del sangrado uterino anormal hasta el momento. ...
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Background: Abnormal uterine bleeding (AUB) is the most common cause of blood loss. Obesity and overweight are risk factors for AUB. Objective: To compare the association between body mass index (BMI) and tri-ponderal mass index (TMI) with the presence of acute AUB and chronic AUB. Material and methods: Observational, cross-sectional and analytical study. Women between 18 and 45 years of age with an alteration in the regular uterine bleeding pattern were included. Postmenopausal women, carriers of an intrauterine device as a method of family planning who have developed alterations in the menstrual rhythm after it, those who suffered from chronic diseases (chronic kidney disease, diabetes mellitus and uncontrolled hypothyroidism) and those with medication consumption that alter coagulation were not included. Pregnant patients were excluded. Results: A total of 292 women with AUB were analyzed, with a median age of 38.5 (IQR 33-41), with bleeding of 205.4 mL (±142.9) and 116 (39.86%) of them with overweight. When analyzing the BMI with SUA, we found no significant difference in the presence of acute or chronic bleeding in the overweight (p = 0.46) and obese (p = 0.41) groups. When analyzing the IMT with the presence of acute or chronic AUB, it was not possible to find a significant difference in the overweight (p = 0.98) and obesity (p = 0.93) groups. Conclusions: The BMI was compared with the TMI for the presence of AUB, without finding a significant association.
... Igualmente es a tener en cuenta que la obesidad puede ser un epifenómeno o consecuencia de otra enfermedad; por lo que es muy importe realizar un abordaje integral del eje hipotálamo-hipófisisovario, además de excluir otras afecciones, como las alteraciones tiroideas y suprarrenales. 38 A continuación, describimos las afecciones y trastornos menstruales que con mayor frecuencia sobrevienen con obesidad, así como la manera pragmática inicial de su evaluación. ...
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Obesidad en el ciclo vital femenino y su asociación con trastornos menstruales Resumen La obesidad está estrechamente relacionada con trastornos metabólicos y endocrinos. En la salud de la mujer es de resaltar que la obesidad se vincula con alteraciones hor-monales, como anovulación crónica, hiperandrogenismo, infertilidad, incremento en el riesgo cardiovascular, entre otros. En este documento se realiza un abordaje de las alteraciones metabólicas y endocrinas de la mujer con obesidad. Abstract Obesity is closely related to metabolic and endocrine disorders. In women's health, it should be noted that obesity is linked to hormonal disorders, such as chronic anovu-lation, hyperandrogenism, infertility, increased cardiovascular risk, among others. In this document, an approach to the metabolic and endocrine disorders of women with obesity is carried out.
... In addition, obese women's sex hormone-binding globulin (SHBG) dropped while their insulin levels rose, promoting the production of androgens. Ovulation and menstrual disorders, including irregular bleeding, oligomenorrhoea, and amenorrhea, are caused by these changes in gonadal steroid concentrations connected to obesity [22]. ...
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Background Abnormal uterine bleeding associated with ovulatory dysfunction (AUB-O) is a typical gynecological disease that can affect women of various ages. Being able to identify women at risk of AUB-O could allow physicians to take timely action. This study aimed to identify the influencing factors of AUB-O in Chinese women, and then develop and validate a predictive model. Methods In this multicenter case–control study, 391 women with AUB-O and 838 controls who came from nine hospitals in Zhejiang province were recruited between April 2019 and January 2022. All the participants completed a structured questionnaire including general characteristics, lifestyle and habits, menstrual and reproductive history, and previous diseases. The predictive model was developed on a group of 822 women and validated on a group of 407 women. Logistic regression was adopted to investigate the influencing factors and develop the model, and validation was then performed. Results The independent predictive factors of AUB-O were age (OR 1.073, 95% CI 1.046—1.102, P < 0.001), body mass index (OR 1.081, 95% CI 1.016—1.151, P = 0.015), systolic blood pressure (OR 1.016, 95% CI 1.002—1.029, P = 0.023), residence (OR 2.451, 95% CI 1.727—3.478, P < 0.001), plant-based diet (OR 2.306, 95% CI 1.415—3.759, P < 0.001), fruits eating (OR 1.887, 95% CI 1.282—2.776, P = 0.001), daily sleep duration (OR 0.819; 95% CI 0.708—0.946, P = 0.007), multiparous (parity = 1, OR 0.424, 95% CI 0.239—0.752, P = 0.003; parity > 1, OR 0.450, 95% CI 0.247—0.822, P = 0.009), and history of ovarian cyst (OR 1.880, 95% CI 1.305—2.710, P < 0.001). The predictive ability (area under the curve) in the development group was 0.77 (95% CI 0.74—0.81), while in the validation group it was 0.73 (95% CI 0.67—0.79). The calibration curve was in high coincidence with the standard curve in the development group, and similar to the validation group. A tool for AUB-O risk calculation was created. Conclusions Nine influencing factors and a predictive model were proposed in this study, which could identify women who are at high risk of developing AUB-O. This finding highlights the importance of early screening and the lifelong management of ovulatory disorders for women.
... Other causes of menstrual irregularity should be considered before a diagnosis of PCOS is confirmed, including congenital adrenal hyperplasia, androgensecreting tumors, exogenous steroid/androgen exposure, hyperprolactinemia, thyroid dysfunction, and Cushing syndrome [66]. In addition, menstrual irregularities, including oligomenorrhea are common among young women with obesity but without PCOS [69]. ...
Article
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Obesity affects approximately 1 in 5 youth globally and increases the risk of complications during adolescence and young adulthood, including type 2 diabetes, dyslipidemia, hypertension, non-alcoholic fatty liver disease, obstructive sleep apnea, and polycystic ovary syndrome. Children and adolescents with obesity frequently experience weight stigma and have an impaired quality of life, which may exacerbate weight gain. Pediatric obesity is typically defined using sex-, age-, and population-specific body mass index percentiles. Once identified, pediatric obesity should always be managed with lifestyle modification. However, adolescents with obesity may also benefit from anti-obesity medications (AOM), several of which have been approved for use in adolescents by the US Food and Drug Administration, including liraglutide, phentermine/topiramate, and semaglutide. For children with specific, rare monogenic obesity disorders, setmelanotide is available and may lead to significant weight loss. Metabolic and bariatric surgery may be used for the management of severe obesity in youth; though highly effective, it is limited to specialized centers and has had relatively low pediatric uptake. In this narrative review using pediatric-focused data from original research, reviews, clinical practice guidelines, governmental agencies, and pharmaceutical companies, we review obesity-related metabolic complications in youth and management strategies, including AOM and bariatric surgery.
... Patients with an overweight or obese BMI (≥25 kg/m 2 ) were less likely to achieve menstrual suppression with norethindrone 0.35 mg when compared to normal weight individuals. Previous studies demonstrate that obesity contributes to heavy menstrual bleeding due to hyperandrogenism, decreased sex hormone binding globulin concentrations, increased aromatization, hyperinsulinemia, and endometrial hyperplasia [28][29][30][31]. It is therefore possible that norethindrone 0.35 mg does not work as well in this cohort of adolescents, as they are more likely to have heavier bleeding than individuals with a normal BMI. ...
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Objectives: We sought to study factors predictive of achieving menstrual suppression with norethindrone vs. norethindrone acetate in adolescents, as optimal dosing is unknown. Secondary outcomes included analyzing prescriber practices and patient satisfaction. Methods: We performed a retrospective chart review of adolescents ages <18 years presenting to an academic medical center from 2010 to 2022. Data collected included demographics, menstrual history, and norethindrone and norethindrone acetate use. Follow-up was measured at one, three, and 12 months. Main outcome measures were starting norethindrone 0.35 mg, continuing norethindrone 0.35 mg, achieving menstrual suppression, and patient satisfaction. Analysis included Chi-square and multivariate logistic regression. Results: Of 262 adolescents initiating norethindrone or norethindrone acetate, 219 completed ≥1 follow-up. Providers less often started norethindrone 0.35 mg for patients with body mass index ≥25 kg/m2, prolonged bleeding, or younger age at menarche, but more often for patients who were younger, had migraines with aura, or were at risk of venous thromboembolism. Those with prolonged bleeding or older age at menarche were less likely to continue norethindrone 0.35 mg. Obesity, heavy menstrual bleeding, and younger age were negatively associated with achieving menstrual suppression. Patients with disabilities reported greater satisfaction. Conclusions: While younger patients more often received norethindrone 0.35 mg vs. norethindrone acetate, they were less likely to achieve menstrual suppression. Patients with obesity or heavy menstrual bleeding may achieve suppression with higher doses of norethindrone acetate. These results reveal opportunities to improve norethindrone and norethindrone acetate prescribing practices for adolescent menstrual suppression.
... 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]. ...
Article
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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. ...
Article
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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]. ...
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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]. ...
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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
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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.
... The present study also provides important, novel information regarding proliferation and leukocyte migration in the PCOS endometrium. Most importantly, the BMIs did not differ between the study groups, which is crucial, especially in PCOS studies (39,40). However, the women with PCOS were slightly younger than the controls. ...
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.
... 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]. ...
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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). ...
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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). ...
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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.
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This cross-sectional study aimed to explore the association between tinnitus and menstrual cycle disorders in premenopausal women. A total of 558 participants completed a comprehensive questionnaire covering demographics, tinnitus, and gynecological/obstetric history. The analysis investigated the correlation between tinnitus and various menstrual disorders, including dysmenorrhea (primary, secondary, or premenstrual syndrome), as well as different menstrual cycle patterns (regular, hypomenorrhea, menorrhagia, oligomenorrhea, or polymenorrhea). Among the participants, 33% reported experiencing tinnitus, with 74.4% experiencing dysmenorrhea. The most prevalent pathological menstrual pattern was menorrhagia (20%), followed by hypomenorrhea (11.11%). The results revealed a significant increase in tinnitus among premenopausal women with secondary dysmenorrhea (p value < 0.001) or menorrhagia (p value < 0.002) compared with those without tinnitus. Adjustment for confounding variables such as age, income, and psychological health problems did not alter the significant correlations between tinnitus and secondary dysmenorrhea and menorrhagia. Further research is needed to elucidate the nature of this relationship and its underlying mechanisms. Both tinnitus and menstrual disorders can have substantial impacts on the well-being of affected women, and a deeper understanding of these issues could pave the way for improvements in their health care.
Article
Aims: To research menstrual cycle characteristics and related factors among Vietnamese female medical students. Background: Female medical students, juggling demanding academic schedules, face the additional challenge of managing the impact of their monthly cycles on daily routines, academic achievements, and professional obligations. Objective: To investigate the factors influencing the menstrual cycle during this particularly stressful period by surveying these students. Methods: This cross-sectional study was from the 3rd year of female medical students studying fulltime. Results: Individuals in the severe stress group experienced irregular periods in 100% of cases. Dysmenorrhea was the next most prevalent abnormal symptom, affecting 39.7% of students. Furthermore, abdominal pain and lower back pain were the most common symptoms of premenstrual syndrome (PMS). The percentage of menorrhagia in the overweight-obesity group was almost 5 times higher than that of the other groups. Besides, central obesity increased the incidence of menorrhagia by a factor of 19. Average to high levels of physical activity can increase the risk of having dysmenorrhea. Remarkably, students who were affected by COVID-19 in terms of quality of life were also more likely to experience dysmenorrhea. Conclusion: Although most medical students had normal menstrual cycles, abdominal pain and lower back pain were the leading PMS. Moreover, overweight-obesity, central obesity, physical activity, stress, and the COVID-19 pandemic may be relative factors of the menstrual cycle.
Article
Background: Normal hypothalamic-pituitary-ovarian (HPO) endocrine function is essential for female pubertal and psychosocial development and for ongoing adult physical, sexual and psychosocial health. Girls with hypogonadism, any endocrine disorder causing abnormal uterine bleeding (AUB) or with contraception needs may require sex hormone treatment. Challenges include evolving needs of a young girl through the course of sexual maturation, potential health risks related to the use of sex hormones for pubertal induction, hormone replacement therapy (HRT), menstrual management and/or contraception. Summary: To ensure optimal sex hormone treatment, both a comprehensive understanding of the underlying disorder affecting HPO endocrine function and a professional communication with the patient and physicians involved are warranted. In this narrative mini-review, we discuss pubertal induction and HRT for girls with hypogonadism and the management of AUB and contraception for young women up to age 30 years. Additionally, we provide advice on management of AUB and contraception in young women with common conditions including polycystic ovary syndrome, congenital adrenal hyperplasia and others. A PubMed-literature search including articles published over the last 20 years, together with clinical experience of the authors was integrated to provide treatment recommendations. Key message: Sex hormone treatment, where needed, requires comprehensive understanding of a range of available options. When tailored to individual needs, with flexibility to accommodate changing circumstance in young women it is safe, well tolerated and provides both physical and psychosocial health.
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Obesity is a growing public health concern and is associated with a range of menstrual disorders, including heavy menstrual bleeding, oligomenorrhea, dysmenorrhea, and endometrial pathology. Investigations may be more logistically challenging in those in the population with obesity, and because of the heightened risk of endometrial malignancy, there should be a low threshold for biopsy to exclude endometrial hyperplasia. Although treatment modalities for women with obesity are broadly similar to those with a normal BMI, additional consideration must be given to the risks associated with estrogen in obesity. Outpatient management of heavy menstrual bleeding is a developing field and outpatient treatment modalities are preferable in the population with obesity to avoid the morbidity associated with anesthetics.
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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.
Article
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.
Article
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.
Article
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
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.
Article
Background: There are many factors that influence menstrual patterns to become irre­gular, including stress and obesity. Menstrual cycle irregularities can have a serious impact on women's health, which will affect the metabolic, fertility, sexual and reproductive systems. This study aims to analyze the influence of obesity and stress on menstrual cycle disorders with a meta-analysis study. Subjects and Method: This study is a syste­matic study and meta-analysis, with the follow­ing PICO, Population= women of childbearing age. Intervention= obesity and stress. Compa­rison = not obese and not stressed. Outcome = disruption of the menstrual cycle. The articles used in this study were obtained from several databases, including PubMed, ScienceDirect and Google Scholar. The keywords used are "menstrual disorder and obesity and stress", "obesity and menstrual irregularity", "obesity OR stress AND menstrual irregularity OR cross sectional study". The articles included in this study are full text articles with a cross sectional study design. Articles were collected using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 application. Results: Meta-analysis of 8 observational studies showed that obese women were 4 times more likely to have menstrual cycle disorders than normal weight (aOR= 4.19; 95% CI= 1.99 to 8.84; p= 0.002). Meta-analysis of 6 observa­tional studies showed that women with stress had a risk of experiencing menstrual cycle dis­orders 1.28 times compared to women who did not experience stress (aOR= 1.28; 95% CI= 1.13 to 1.45; p = 0.001). Conclusion: Obesity and stress affect menstrual cycle disorders.
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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.
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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 determine why women choose endometrial ablation rather than hysterectomy for the treatment of menorrhagia. Observational study based on postal questionnaires. A university hospital. One hundred eighty randomly selected patients from a cohort of 658 patients who underwent endometrial ablation for the treatment of menorrhagia during the past 7 years. None. Patient attitude about endometrial ablation. One hundred six questionnaires (58.9%) were completed satisfactorily. The average postoperative follow-up period was 45.1 months (range, 3-80 months). Eleven women (10.4%) had undergone repeated endometrial ablation and 8 (7.5%) had undergone hysterectomy. More than half the women indicated that they would find endometrial ablation acceptable even if there was no chance of amenorrhea, if the probability of menstruation becoming lighter was > or = 4:10, if the likelihood of menstrual pain decreasing was > or = 3:10, if the chance of requiring repeated endometrial ablation or hysterectomy was < or = 1:4, and if the risk of uterine cancer after surgery was < or = 1:200. The three most important advantages of endometrial ablation over hysterectomy were perceived to be the avoidance of major surgery, the fast return to normal functioning, and the short hospitalization. Most women who choose endometrial ablation rather than hysterectomy as therapy for menorrhagia are prepared to undergo hysteroscopic surgery even if the chance of success is relatively poor.
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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).
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
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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.).
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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.
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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)