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Reproductive Biology and Endocrinology... May 2017Premature ovarian insufficiency (POI) is a typical disorder of amenorrhea lasting for a minimum of 4 months. The typical characteristics comprised of declined estrogen... (Review)
Review
Premature ovarian insufficiency (POI) is a typical disorder of amenorrhea lasting for a minimum of 4 months. The typical characteristics comprised of declined estrogen and raised serum concentrations of follicle-stimulating hormone (FSH) in women <40-year-old, primarily originating from iatrogenic factors, karyotypic abnormalities, and genetic factors. However, the etiology of POI remains unknown in approximately 90% of cases. POI could lead to infertility, osteoporosis, cardiovascular disorder, and cognitive dysfunction. MicroRNAs (miRNAs) are a class of endogenous noncoding RNAs (ncRNAs) that can mediate post-translational silencing of the genes involved in the regulation of proliferation, differentiation, apoptosis, development, tumorigenesis, and hematopoiesis. Recently, the regulatory functions of miRNAs in the development of POI have been the topic of intensive research. The present review addresses the association of miRNAs' machinery genes (Dicer, Drosha, and XPO5) with POI and the miRNA expression profiles in the plasma of patients with POI. In addition, several specific miRNAs (miR-23a, miR-27a, miR-22-3p, miR-146a, miR-196a, miR-290-295, miR-423, and miR-608) related to POI are also examined in order to highlight the issues that deserve further investigation. A thorough understanding of the exact regulatory roles of miRNAs is imperative to gain novel insights into the etiology of idiopathic POI and offer new research directions in the field.
Topics: Adult; Amenorrhea; Female; Humans; MicroRNAs; Middle Aged; Primary Ovarian Insufficiency
PubMed: 28499456
DOI: 10.1186/s12958-017-0256-3 -
The Journal of the American Academy of... Jul 2015After the passage of Title IX in 1972, female sports participation skyrocketed. In 1992, the female athlete triad was first defined; diagnosis required the presence of... (Review)
Review
After the passage of Title IX in 1972, female sports participation skyrocketed. In 1992, the female athlete triad was first defined; diagnosis required the presence of an eating disorder, amenorrhea, and osteoporosis. However, many athletes remained undiagnosed because they did not meet all three of these criteria. In 2007, the definition was modified to a spectrum disorder involving low energy availability (with or without disordered eating), menstrual dysfunction, and low bone mineral density. With the new definition, all three components need not be present for a diagnosis of female athlete triad. Studies using the 1992 definition of the disorder demonstrated a prevalence of 1% to 4% in athletes. However, in certain sports, many female athletes may meet at least one of these criteria. The actual prevalence of athletes who fall under the "umbrella" diagnosis of the female athlete triad remains unknown.
Topics: Amenorrhea; Bone Density; Evidence-Based Medicine; Feeding and Eating Disorders; Female; Female Athlete Triad Syndrome; Global Health; Guidelines as Topic; Humans; Osteoporosis; Prevalence; Sports
PubMed: 26111876
DOI: 10.5435/JAAOS-D-14-00168 -
Journal of Endocrinological... Nov 2014Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and... (Review)
Review
INTRODUCTION
Functional hypothalamic amenorrhea (FHA) is one of the most common causes of secondary amenorrhea. There are three types of FHA: weight loss-related, stress-related, and exercise-related amenorrhea. FHA results from the aberrations in pulsatile gonadotropin-releasing hormone (GnRH) secretion, which in turn causes impairment of the gonadotropins (follicle-stimulating hormone and luteinizing hormone). The final consequences are complex hormonal changes manifested by profound hypoestrogenism. Additionally, these patients present mild hypercortisolemia, low serum insulin levels, low insulin-like growth factor 1 (IGF-1) and low total triiodothyronine.
AIM
The aim of this work is to review the available data concerning the effects of FHA on different aspects of women's health.
RESULTS
Functional hypothalamic amenorrhea is related to profound impairment of reproductive functions including anovulation and infertility. Women's health in this disorder is disturbed in several aspects including the skeletal system, cardiovascular system, and mental problems. Patients manifest a decrease in bone mass density, which is related to an increase in fracture risk. Therefore, osteopenia and osteoporosis are the main long-term complications of FHA. Cardiovascular complications include endothelial dysfunction and abnormal changes in the lipid profile. FHA patients present significantly higher depression and anxiety and also sexual problems compared to healthy subjects.
CONCLUSIONS
FHA patients should be carefully diagnosed and properly managed to prevent both short- and long-term medical consequences.
Topics: Amenorrhea; Animals; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Luteinizing Hormone; Osteoporosis; Reproduction; Women's Health
PubMed: 25201001
DOI: 10.1007/s40618-014-0169-3 -
Orvosi Hetilap Nov 2015Polycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder likely to affect women. The heterogeneous endocrinopathy is characterized by... (Review)
Review
Polycystic ovary syndrome is recognized as the most common hormonal and metabolic disorder likely to affect women. The heterogeneous endocrinopathy is characterized by clinical and/or biochemical hyperandrogenism, oligo- or amenorrhoea, anovulatory infertility, and polycystic ovarian morphology. The syndrome is often associated with obesity, hyperinsulinemia and adversely affects endocrine, metabolic, and cardiovascular health. The symptoms and complaint of the patients vary with age. To maximise health gain of the syndrome, adequate, evidence based effective, efficient and safe treatment is necessary. This article summarises the highest available evidence provided by studies, meta-analysis and systematic reviews about the therapeutical possibilities for treating obesity, hyperandrogenism, menstrual abnormalities, infertility and psychological problems related to polycystic ovary syndrome.
Topics: Amenorrhea; Androgen Antagonists; Anovulation; Anti-Obesity Agents; Chorionic Gonadotropin; Contraceptives, Oral, Hormonal; Depression; Evidence-Based Medicine; Female; Hirsutism; Humans; Hyperandrogenism; Hyperinsulinism; Hypoglycemic Agents; Infertility, Female; Insulin Resistance; Metformin; Obesity; Polycystic Ovary Syndrome; Risk Reduction Behavior
PubMed: 26551444
DOI: 10.1556/650.2015.30253 -
Journal of Pediatric and Adolescent... Apr 2021Hypothalamic amenorrhea is common in adolescents and young adults (AYAs) with anorexia nervosa (AN), and ovarian reserve is not routinely assessed. AN increases rates of...
STUDY OBJECTIVES
Hypothalamic amenorrhea is common in adolescents and young adults (AYAs) with anorexia nervosa (AN), and ovarian reserve is not routinely assessed. AN increases rates of fertility problems, but how or when AN negatively influences future fertility is unclear. We sought to determine whether biomarkers of ovarian reserve were impacted in AYA with AN.
DESIGN
Cross-sectional study.
SETTING
Tertiary care center.
PARTICIPANTS
Females with AN and amenorrhea (n = 97) at the pre-intervention visit of a clinical trial, n = 19 females without an eating disorder or menstrual dysfunction.
MAIN OUTCOME MEASURES
Serum anti-Müllerian hormone (AMH) concentrations.
RESULTS
AMH levels were higher in AYA with AN than unaffected adolescents (4.7 vs. 3.2 ng/mL; P = .03). Neither FSH nor inhibin B differed between groups. In 19.6% of participants with AN, AMH levels were elevated above the normal range (>6.78 ng/mL). These subjects had a longer disease duration than those with normal AMH levels (9 vs. 3 mos; P = .03); age or degree of malnutrition did not differ between AN subjects with normal or elevated AMH.
CONCLUSIONS
AMH levels appear to be normal or elevated in AYA with AN. Low AMH in a patient with AN should raise clinical concern regarding ovarian reserve, and should not be attributed to degree of malnutrition alone. Currently, AMH is not regularly assessed during routine AN clinical care. However, our findings suggest some clinical utility in identifying those patients with reduced ovarian reserve. Potential links between the hypothalamic amenorrhea suffered by patients with AN and PCOS should be explored.
Topics: Adolescent; Amenorrhea; Anorexia Nervosa; Anti-Mullerian Hormone; Clinical Trials as Topic; Cross-Sectional Studies; Female; Humans; Ovarian Diseases; Ovarian Reserve; Research Subjects; Young Adult
PubMed: 33278562
DOI: 10.1016/j.jpag.2020.11.021 -
Expert Opinion on Therapeutic Targets 2016Kisspeptins are a family of neuropeptides whose identification has become one of the biggest discoveries in reproductive endocrinology during the past decade.... (Review)
Review
INTRODUCTION
Kisspeptins are a family of neuropeptides whose identification has become one of the biggest discoveries in reproductive endocrinology during the past decade. Kisspeptins act upstream of GnRH as high-level mediators of the reproductive axis.
AREAS COVERED
The authors performed a search of all publications on kisspeptin since its discovery in 1996. A full appraisal of the expanding literature concerning kisspeptin is beyond the scope of this review. This article therefore aims to cover the principle human studies outlining kisspeptin action in human physiology and to discuss the key findings, describing kisspeptin's potential as a therapeutic target in human reproduction.
EXPERT OPINION
The identification of the kisspeptin signaling pathway has greatly advanced the study of reproductive endocrinology. Building on a large body of animal data, a growing number of human studies have shown that exogenous kisspeptin can stimulate physiological gonadotropin responses in both healthy subjects and those with disorders of reproduction. There is an increasing appreciation that kisspeptin may act as a signal transmitter between metabolic status and reproductive function. Future work is likely to involve investigation of novel kisspeptin analogs and further exploration of role of neurokinin B and dynorphin on the kisspeptin-GnRH axis.
Topics: Amenorrhea; Animals; Female; Humans; Hypogonadism; Kisspeptins; Menopause; Ovulation; Reproduction
PubMed: 26605678
DOI: 10.1517/14728222.2016.1124858 -
Journal of Musculoskeletal & Neuronal... Dec 2023The study objective was to assess bone quality measured by high resolution peripheral quantitative computed tomography (HR-pQCT) in competitive athletes. Medline, EMBASE... (Review)
Review
The study objective was to assess bone quality measured by high resolution peripheral quantitative computed tomography (HR-pQCT) in competitive athletes. Medline, EMBASE and Sport Discus were searched through May 2022. Prior to submission, a follow-up database search was performed (January 2023). Studies of competitive athletes using HR-pQCT to assess bone quality were included. Athletes were aged between 14 and 45 years. Data extraction included study design and location (country), skeletal imaging modality and site, bone variables and any additional musculoskeletal-related outcome. Information identifying sports and athletes were also extracted. This review included 14 manuscripts and a total of 928 individuals (male: n=75; female: n=853). Athletes comprised 78% (n=722) of the included individuals and 93% of athletes were female. Assessment scores indicate the studies were good to fair quality. The athletes included in this review can be categorized into three groups: 1) healthy athletes, 2) athletes with compromised menstrual function (e.g., amenorrhoea), and 3) athletes with compromised bone health (e.g., bone stress injuries). When assessing bone quality using HR-pQCT, healthy competitive athletes had denser, stronger and larger bones with better microarchitecture, compared with controls. However, the same cannot be said for athletes with amenorrhoea or bone stress injuries.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Middle Aged; Bone Density; Amenorrhea; Bone and Bones; Tomography, X-Ray Computed; Athletes; Radius
PubMed: 38037364
DOI: No ID Found -
Current Opinion in Pediatrics Aug 2015We provide an overview of new insights into the genetic causes of primary ovarian insufficiency (POI) and address the challenges faced by clinicians who care for... (Review)
Review
PURPOSE OF REVIEW
We provide an overview of new insights into the genetic causes of primary ovarian insufficiency (POI) and address the challenges faced by clinicians who care for adolescents with this condition.
RECENT FINDINGS
In most cases, the cause of POI remains a mystery after appropriate clinical testing has been completed. Large-scale genomic sequencing approaches are uncovering new mechanisms underlying the disorder. Gene variants that affect the normal processes of primordial germ-cell proliferation and migration, oocyte meiosis, and ovarian follicle formation/activation are plausible mechanisms. Whole exome sequencing has been used to associate many of these variants with human POI. POI is a serious chronic condition with no cure. It qualifies as a rare disease and as such presents special challenges to patients, parents, and clinicians. Although the diagnosis of POI is often delayed because of the assumption that irregular menses are common among adolescents, early detection is critical for the maintenance of bone and cardiovascular health. Treatment options have focused on hormonal therapy and fertility preservation. However, many studies prove the increasing need to incorporate mental health support and a family systems approach into the management plan.
SUMMARY
Large-scale genomic sequencing has recently identified new mechanisms of POI. However, at present this testing is not clinically indicated as routine. Practice will change as genomic medicine is integrated into standard care. Adolescents with POI are best served by an integrated personal care approach centered on the patient and provided by a primary care clinician who has support from a multidisciplinary team.
Topics: Adolescent; Amenorrhea; Early Diagnosis; Estrogen Replacement Therapy; Female; Fertility Preservation; Fragile X Mental Retardation Protein; Genetic Counseling; Humans; Infertility, Female; Parents; Primary Ovarian Insufficiency
PubMed: 26087426
DOI: 10.1097/MOP.0000000000000236 -
Journal of Ayub Medical College,... 2021Amenorrhoea is absence of menstruation. It could be primary, if menstruation has not occurred by the age of 16 years in the presence of normal growth and secondary...
BACKGROUND
Amenorrhoea is absence of menstruation. It could be primary, if menstruation has not occurred by the age of 16 years in the presence of normal growth and secondary sexual characters or by the age of 14 years in the absence of secondary sexual characters. It is secondary if periods have not occurred for six months. This study was done with the objective to determine the frequency of etiologic causes of primary amenorrhoea.
STUDY DESIGN
Cross-sectional descriptive study.
METHODS
The study was conducted in the department of Obstetrics and Gynaecology Sheikh Khalifha Bin Zyed Al Nahyan /Combined Military Hospital Muzaffarabad Azad Jammu Kashmir (SKBZ/CMH MZD AJK) from December 2014 to November 2017. Women with primary amenorrhoea reported and managed in the hospital are included in the study. Cases were analysed according to clinical profile, development of secondary sexual characteristics, physical examination, pelvic and rectal examination, hormonal profile, pelvic ultrasound, magnetic resonance imaging and cytogenetic study including karyotyping..
RESULTS
Three most common causes of primary amenorrhoea were Mullerian anomalies (36.7%) followed by gonadal dysgenesis (33.3%), hypothalamic causes (23.3%) and Pituitary causes (6.7%). There were 03 cases of polycystic ovarian syndrome and 02 cases of hyperprolactinemia.
CONCLUSIONS
The most common etiological factor leading to primary amenorrhoea is Mullerian anomalies followed by gonadal dysgenesis. Genetic and environmental factors could also play role in the causes of primary amenorrhoea.
Topics: Adolescent; Adult; Amenorrhea; Cross-Sectional Studies; Female; Gonadal Dysgenesis; Humans; Karyotyping; Magnetic Resonance Imaging; Pregnancy
PubMed: 34137542
DOI: No ID Found -
Calcified Tissue International May 2017This article reviews the effects of restrictive eating disorders on bone health. The relationship between eating disorders and amenorrhea is discussed in detail. The... (Review)
Review
This article reviews the effects of restrictive eating disorders on bone health. The relationship between eating disorders and amenorrhea is discussed in detail. The pathologic impact of malnutrition on bone is explored by examining the results of studies using various available imaging techniques. The multiple hormonal alterations seen in adolescents and young women with anorexia nervosa are reviewed, as well as how these alterations may influence bone turnover, density, structure, and strength. The diagnostic clinical evaluation for adolescents and young women with these disorders is also outlined. Available treatment options, including those that hold promise for efficacy, as well as those we deemed to be ineffective, are considered from both the clinical and mechanistic standpoints. Finally, future research opportunities are offered, including intriguing work in the area of fat and bone interactions.
Topics: Adolescent; Adult; Amenorrhea; Bone and Bones; Feeding and Eating Disorders; Female; Humans; Young Adult
PubMed: 27339670
DOI: 10.1007/s00223-016-0164-0