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The Journal of Clinical Endocrinology... Sep 2013Adolescents are at high risk for menstrual dysfunction. The diagnosis of anovulatory disorders that may have long-term health consequences is too often delayed. (Review)
Review
CONTEXT
Adolescents are at high risk for menstrual dysfunction. The diagnosis of anovulatory disorders that may have long-term health consequences is too often delayed.
EVIDENCE ACQUISITION
A review of the literature in English was conducted, and data were summarized and integrated from the author's perspective.
MAIN FINDINGS
Normal adolescent anovulation causes only minor menstrual cycle irregularity: most cycles range from 21-45 days, even in the first postmenarcheal year, 90% by the fourth year. Approximately half of symptomatic menstrual irregularity is due to neuroendocrine immaturity, and half is associated with increased androgen levels. The former is manifest as aluteal or short/deficient luteal phase cycles and usually resolves spontaneously. The latter seems related to polycystic ovary syndrome because adolescent androgen levels are associated with adult androgens and ovulatory dysfunction, but data are sparse. Obesity causes hyperandrogenemia and, via unclear mechanisms, seems to suppress LH; it may mimic polycystic ovary syndrome. The role of pubertal insulin resistance in physiological adolescent anovulation is unclear. High-sensitivity gonadotropin and steroid assays, the latter by specialty laboratories, are necessary for accurate diagnosis of pubertal disorders. Polycystic ovaries are a normal ultrasonographic finding in young women and are associated with nearly 2-fold increased anti-Müllerian hormone levels. Oral contraceptives are generally the first-line treatment for ongoing menstrual dysfunction, and the effects of treatment are similar among preparations.
CONCLUSIONS
Menstrual cycle duration persistently outside 21-45 days in adolescents is unusual, and persistence ≥ 1 year suggests that disordered hypothalamic-pituitary-gonadal function be considered. Research is needed on the mechanisms and prognosis of adolescent anovulation.
Topics: Adolescent; Anovulation; Female; Humans; Menstrual Cycle; Menstruation Disturbances; Ovary; Pituitary Gland; Polycystic Ovary Syndrome
PubMed: 23913942
DOI: 10.1210/jc.2013-1770 -
Biomedicines Apr 2024Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than... (Review)
Review
Endometrial cancer is the most common gynecologic malignancy in developed countries, and the incidence is rising in premenopausal females. Type I EC is more common than Type II EC (80% vs. 20%) and is associated with a hyperestrogenic state. Estrogen unopposed by progesterone is considered to be the main driving factor in the pathogenesis of EC. Studies show that BMI > 30 kg/m, prolonged duration of menses, nulliparity, presence of polycystic ovarian syndrome, and Lynch syndrome are the most common causes of EC in premenopausal women. Currently, there are no guidelines established to indicate premenopausal patients who should be screened. This review aims to synthesize current data on the etiology, risk factors, presentation, evaluation, and prognosis of endometrial cancer in this population.
PubMed: 38672240
DOI: 10.3390/biomedicines12040886 -
The Journal of Family Planning and... Apr 2014Extended use of the combined oral contraceptive pill (COC), defined as taking active pills for at least 28 days, has been used in order to avoid bleeding at... (Review)
Review
BACKGROUND
Extended use of the combined oral contraceptive pill (COC), defined as taking active pills for at least 28 days, has been used in order to avoid bleeding at important times and to treat gynaecological conditions such as endometriosis. We examined the main issues involved in extended use of the COC and how it has evolved from being one of medicine's best-kept secrets to becoming more widely accepted by women and the medical community.
STUDY DESIGN
Literature review, using Medline, Embase, Pubmed, CINHAL Plus, the Cochrane Database of Systematic Reviews and the Ovid database for all relevant clinical trials, systematic reviews, meta-analyses, literature reviews, scientific papers and individual opinions between 1950 and October 2013.
RESULTS
Accumulating evidence supports various forms of extended pill use as suitable alternatives to the standard (21/7) regimen. In terms of user preference, much hinges on whether women wish to reduce the frequency or duration of scheduled bleeding on the combined pill. Available data on the safety of extended pill regimens do not give cause for concern, but longer term data should be collected.
CONCLUSIONS
Information for women considering extended COC regimens should keep pace with research findings to ensure that women and clinicians are better informed about the choices available.
Topics: Contraceptives, Oral, Combined; Drug Administration Schedule; Endometrium; Female; Humans; Medication Adherence; Menstruation; Menstruation Disturbances; Time Factors
PubMed: 24648529
DOI: 10.1136/jfprhc-2013-100600 -
The Journal of Adolescent Health :... Oct 2015The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to...
PURPOSE
The purpose of this study was to improve understanding of adolescents' reasons for choosing an intrauterine device (IUD) and to explore experiences that led to continuation or discontinuation of the levonorgestrel intrauterine system (LNG-IUS) and the copper IUD (copper IUD).
METHODS
We conducted focus groups (FGs) with adolescents and young women who were current or former IUD users stratified by IUD type and 12-month IUD continuation or discontinuation. All subjects were participants from the Contraceptive CHOICE Project. FG data were supplemented with in-depth interviews (IDIs). Data collection was continued until thematic saturation was reached. Transcripts were independently coded by two researchers, and interrater reliability was calculated using a Kappa coefficient. Analysis followed a standard text-analysis approach.
RESULTS
Thirteen FGs and seven IDIs were conducted with 43 young women. Effectiveness, duration of use, convenience, and potential bleeding changes emerged as themes for both choosing and continuing IUDs. Some women chose the LNG-IUS to achieve amenorrhea, whereas copper IUD users wanted a nonhormonal method and continued menses. Copper IUD users cited expulsion and bleeding irregularities as reasons for discontinuation, whereas LNG-IUS users reported bleeding irregularities and continued pain as reasons for removal. IUD users noted an adjustment period of weeks to months in which side effects were present before lessening.
CONCLUSIONS
Effectiveness, duration of use, convenience, and potential changes in bleeding patterns drove adolescents' choice and continuation of an IUD. Bleeding changes and pain contributed to IUD discontinuation. Discussion of effectiveness, duration and convenience, and anticipatory guidance regarding post-insertion side effects may be important in counseling young women about IUDs.
Topics: Adolescent; Adolescent Behavior; Contraception Behavior; Female; Focus Groups; Follow-Up Studies; Humans; Intrauterine Devices, Copper; Male; Menstruation; Qualitative Research; Uterine Hemorrhage
PubMed: 26126950
DOI: 10.1016/j.jadohealth.2015.05.001 -
Human Reproduction (Oxford, England) Mar 2018What is the association between perimenarchal exposure to total suspended particulate (TSP) in air, menstrual irregularity phenotypes and time to menstrual cycle...
STUDY QUESTION
What is the association between perimenarchal exposure to total suspended particulate (TSP) in air, menstrual irregularity phenotypes and time to menstrual cycle regularity?
SUMMARY ANSWER
Exposures to TSP during high school are associated with slightly increased odds of menstrual irregularity and longer time to regularity in high school and early adulthood.
WHAT IS KNOWN ALREADY
The menstrual cycle is responsive to hormonal regulation. Particulate matter air pollution has demonstrated hormonal activity. However, it is not known if air pollution is associated with menstrual cycle regularity.
STUDY DESIGN, SIZE, DURATION
Cross sectional study of 34 832 of the original 116 430 women (29.91%) enrolled in 1989 from the Nurses' Health Study II (NHSII). The follow-up rate for this analytic sample was 97.76% at the 1991 survey.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Annual averages of TSP were available for each year of high school attendance. We created three case definitions including high school menstrual irregularity and androgen excess. The time to menstrual cycle regularity was reported by participants as <1 year, 1-2 years, 3-4 years, 5 years or longer, or never on the baseline questionnaire. Odds ratios and 95% confidence intervals (CI) were calculated for 45 μg/m3 increases in TSP exposure, adjusted for risk factors for menstrual irregularity.
MAIN RESULTS AND THE ROLE OF CHANCE
In multivariable adjusted models, we observed that for every 45 μg/m3 increase in average high school TSP there was an increased odds (95%CI) of 1.08 (1.03-1.14), 1.08 (1.02-1.15) and 1.10 (0.98-1.25) for moderate, persistent, and persistent with androgen excess irregularity phenotypes, respectively. TSP was also associated with a longer time to cycle regularity, with stronger results among women with older ages at menarche and those living in the Northeast or the West.
LIMITATIONS, REASONS FOR CAUTION
The outcomes of menstrual regularity and time to cycle regularity were retrospectively assessed outcomes and may be susceptible to recall bias. There is also the potential for selection bias, as women had to live until 2011 to provide addresses.
WIDER IMPLICATIONS OF THE FINDINGS
Temporal exposure to air pollution in the adolescent and early adulthood window may be especially important, given its association with phenotypes of menstrual irregularity. The data from this study agrees with existing literature regarding air pollution and reproductive tract diseases.
STUDY FUNDING/COMPETING INTEREST(S)
Shruthi Mahalingaiah: Reproductive Scientist Development Program HD000849, and a research grant from the Boston University Department of Obstetrics and Gynecology, Stacey Missmer: R01HD57210 from the National Institute of Child Health and Human Development and the Massachusetts Institute of Technology Center for Environmental Health Sciences Translational Pilot Project Program, R01CA50385 from the National Cancer Institute, Jaime Hart and Francine Laden: 5R01ES017017 from the National Institute for Environmental Health Sciences, Jaime Hart: P30 ES00002 from the National Institute for Environmental Health Sciences at the National Institute of Health, The Nurses' Health Study II is supported by infrastructure grant UM1CA176726 from the National Cancer Institute, NIH, U.S. Department of Health and Human Services The authors have no conflicts of interest to declare.
Topics: Adolescent; Adult; Air Pollutants; Air Pollution; Child; Environmental Exposure; Female; Humans; Menarche; Menstruation Disturbances; Retrospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 29377993
DOI: 10.1093/humrep/dey005 -
Proceedings of the National Academy of... Jul 2021The contraceptive effect of breastfeeding remains essential to controlling fertility in many developing regions of the world. The extent to which this negative effect of...
The contraceptive effect of breastfeeding remains essential to controlling fertility in many developing regions of the world. The extent to which this negative effect of breastfeeding on ovarian activity is sensitive to ecological conditions, notably maternal energetic status, has remained controversial. We assess the relationship between breastfeeding duration and postpartum amenorrhea (the absence of menstruation following a birth) in 17 World Fertility Surveys and 284 Demographic Health Surveys conducted between 1975 and 2019 in 84 low- and middle-income countries. We then analyze the resumption of menses in women during unsupplemented lactation. We find that a sharp weakening of the breastfeeding-postpartum amenorrhea relationship has globally occurred over the time period analyzed. The slope of the breastfeeding-postpartum amenorrhea relationship is negatively associated with development: higher values of the Human Development Index, urbanization, access to electricity, easier access to water, and education are predictive of a weaker association between breastfeeding and postpartum amenorrhea. Low parity also predicts shorter postpartum amenorrhea. The association between exclusive breastfeeding and maintenance of amenorrhea in the early postpartum period is also found in rapid decline in Asia and in moderate decline in sub-Saharan Africa. These findings indicate that the effect of breastfeeding on ovarian function is partly mediated by external factors that likely include negative maternal energy balance and support the notion that prolonged breastfeeding significantly helps control fertility only under harsh environmental conditions.
Topics: Adolescent; Adult; Africa South of the Sahara; Amenorrhea; Asia; Breast Feeding; Contraception; Female; Humans; Middle Aged; Postpartum Period; Pregnancy; Socioeconomic Factors; Young Adult
PubMed: 34253613
DOI: 10.1073/pnas.2025348118 -
BMC Zoology Feb 2022The Egyptian spiny mouse (Acomys cahirinus) is the only known rodent to exhibit true, human-like menstruation and postpartum ovulation, and is an important new model for...
BACKGROUND
The Egyptian spiny mouse (Acomys cahirinus) is the only known rodent to exhibit true, human-like menstruation and postpartum ovulation, and is an important new model for reproductive studies. Spiny mice do not produce a visible copulatory plug, and calculation of gestational age is therefore restricted by the need to use mated postpartum dams. The current inefficient method of monitoring until parturition to provide a subsequent estimate of gestational age increases study duration and costs. This study addressed this issue by comparing the mating behaviour of spiny mice across the menstrual cycle and proposes a more accurate method for staging and pairing animals that provides reliable estimates of gestational age. In experiment 1, mating behaviour was recorded overnight to collect data on mounting, intromission, and ejaculation (n = 5 pairs per stage) in spiny mice paired at menses and at early and late follicular and luteal phases of the menstrual cycle. In experiment 2, female spiny mice were paired at the follicular or luteal phases of the menstrual cycle to determine any effect on the pairing-birth interval (n = 10 pairs).
RESULTS
We report a broad mating window of ~ 3 days during the follicular phase and early luteal phase of spiny mice. Males displayed a discrete 'foot twitch' behaviour during intromission and a brief copulatory lock during ejaculation. Litters were delivered after 40-43 days if pairing occurred during the mating window, compared with 46-48 days for spiny mice paired in the late luteal phase. When pairing occurred during the late luteal phase or menses no mating activity was observed during the recording period.
CONCLUSION
This study clearly demonstrates an effect of the menstrual cycle on mating behaviour and pregnancy in the spiny mouse and provides a reliable and more effective protocol for estimating gestational age without the need for postpartum dams.
PubMed: 37170145
DOI: 10.1186/s40850-022-00112-1 -
Annals of Cardiac Anaesthesia 2022Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are...
BACKGROUND
Cancellation of any scheduled surgery is a significant drain on health resources and potentially stressful for patients. It is frequent in menstruating women who are scheduled to undergo open heart surgery (OHS), based on the widespread belief that it increases surgical and menstrual blood loss.
AIMS
The aim of this study was to evaluate blood loss in women undergoing OHS during menstruation.
SETTINGS AND DESIGN
A prospective, matched case-control study which included sixty women of reproductive age group undergoing OHS.
PATIENTS AND METHODS
The surgical blood loss was compared between women who were menstruating (group-M; n = 25) and their matched controls, i.e., women who were not menstruating (group-NM; n = 25) at the time of OHS. Of the women in group M, the menstrual blood loss during preoperative (subgroup-P) and perioperative period (subgroup-PO) was compared to determine the effect of OHS on menstrual blood loss.
RESULTS
The surgical blood loss was comparable among women in both groups irrespective of ongoing menstruation (gr-M = 245.6 ± 120.1 ml vs gr-NM = 243.6 ± 129.9 ml, P value = 0.83). The menstrual blood loss was comparable between preoperative and perioperative period in terms of total menstrual blood loss (gr-P = 36.8 ± 4.8 ml vs gr-PO = 37.7 ± 5.0 ml, P value = 0.08) and duration of menstruation (gr-P = 4.2 ± 0.6 days vs gr-PO = 4.4 ± 0.6 days, P value = 0.10).
CONCLUSION
Neither the surgical blood loss nor the menstrual blood loss is increased in women undergoing OHS during menstruation.
Topics: Blood Loss, Surgical; Cardiac Surgical Procedures; Case-Control Studies; Female; Humans; Menstruation; Prospective Studies
PubMed: 35799559
DOI: 10.4103/aca.aca_83_21 -
Clinical Endocrinology Mar 2018Women with type 1 diabetes have increased risk of infertility compared to women without diabetes even after adjustment for irregular menses, but aetiologies are... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Women with type 1 diabetes have increased risk of infertility compared to women without diabetes even after adjustment for irregular menses, but aetiologies are incompletely understood. Our aim was to examine the prevalence of abnormalities in ovarian markers consistent with polycystic ovary syndrome in women with type 1 diabetes and associations with irregular menses and diabetes-specific variables.
DESIGN, PATIENTS AND MEASUREMENTS
We conducted a secondary analysis of women in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC), a randomized trial and observational follow-up of intensive insulin therapy for type 1 diabetes. We included women with anti-Müllerian hormone (AMH) measurements among women not using oral contraceptives (n = 187). Initial AMH and testosterone measures were performed between EDIC years 1 and 4. History of irregular menses was assessed annually.
RESULTS
The median age of women was 35 (interquartile ratio 29, 40) years; 133 (35%) had elevated AMH and 62 (17%) reported irregular menses. Twelve per cent of women had relative elevations in total testosterone. In multivariable models, lower insulin dosages were associated with higher AMH concentrations (P = .0027), but not diabetes duration, glycemic control, body mass index or irregular menses. Neither irregular menses nor diabetes-specific variables were associated with testosterone concentrations.
CONCLUSIONS
Among women with type 1 diabetes in their thirties, abnormalities in ovarian markers are common and not associated with irregular menses and thus may partially account for decreased fecundity in women with type 1 diabetes.
Topics: Adult; Anti-Mullerian Hormone; Biomarkers; Diabetes Mellitus, Type 1; Female; Follow-Up Studies; Humans; Infertility, Female; Insulin; Menstruation Disturbances; Ovary; Polycystic Ovary Syndrome
PubMed: 29314138
DOI: 10.1111/cen.13546 -
Evidence-based Complementary and... 2019Danshen, the root of Bunge, is a traditional herbal medicine in China, which has been used to treat irregular menstruation, cold hernia, and abdominal pain for... (Review)
Review
OBJECTIVE
Danshen, the root of Bunge, is a traditional herbal medicine in China, which has been used to treat irregular menstruation, cold hernia, and abdominal pain for thousands of years. Danshen is frequently used in combination with drugs to treat cardiovascular diseases. Clopidogrel is a commonly used drug for treating coronary heart disease, but clopidogrel resistance restricts its development. Therefore, the clinical efficacy of Danshen combined with clopidogrel treats coronary heart disease and the relationship between Danshen and clopidogrel metabolism enzymes is suggested for future investigations.
MATERIALS AND METHODS
The information was collected by searching online databases, and the RevMan 5.3 software was used to perform meta-analysis.
RESULTS
Twenty-two articles, including 2587 patients, were enrolled after the evaluation. Meta-analysis showed that Danshen combined with clopidogrel was more effective than clopidogrel alone in treating coronary heart disease by improving clinical curative effect, reducing the frequency of angina pectoris, improving electrocardiogram results, shortening the duration of angina pectoris, and easing adverse reactions. Danshen inhibited carboxylesterase 1 and most enzyme of cytochrome P450, especially cytochrome P450 1A2, which may affect the metabolism of clopidogrel.
CONCLUSION
Danshen combined with clopidogrel may compensate for individual differences of clopidogrel resistance among individuals in the treatment of coronary heart disease. Meanwhile, the inhibitory effect of Danshen on cytochrome P450 and carboxylesterase 1 could be partly responsible for the synergistic and attenuating effects of Danshen combined with clopidogrel.
PubMed: 30911318
DOI: 10.1155/2019/2721413