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Human Reproduction (Oxford, England) Jul 2021Does increased daily energy intake lead to menstrual recovery in exercising women with oligomenorrhoea (Oligo) or amenorrhoea (Amen)? (Randomized Controlled Trial)
Randomized Controlled Trial
STUDY QUESTION
Does increased daily energy intake lead to menstrual recovery in exercising women with oligomenorrhoea (Oligo) or amenorrhoea (Amen)?
SUMMARY ANSWER
A modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen.
WHAT IS KNOWN ALREADY
Optimal energy availability is critical for normal reproductive function, but the magnitude of increased energy intake necessary for menstrual recovery in exercising women, along with the associated metabolic changes, is not known.
STUDY DESIGN, SIZE, DURATION
The REFUEL study (trial # NCT00392873) is the first randomised controlled trial to assess the effectiveness of 12 months of increased energy intake on menstrual function in 76 exercising women with menstrual disturbances. Participants were randomised (block method) to increase energy intake 20-40% above baseline energy needs (Oligo/Amen + Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36). The study was performed from 2006 to 2014.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Participants were Amen and Oligo exercising women (age = 21.0 ± 0.3 years, BMI = 20.8 ± 0.2 kg/m2, body fat = 24.7 ± 0.6%) recruited from two universities. Detailed assessment of menstrual function was performed using logs and measures of daily urinary ovarian steroids. Body composition and metabolic outcomes were assessed every 3 months.
MAIN RESULTS AND THE ROLE OF CHANCE
Using an intent-to-treat analysis, the Oligo/Amen + Cal group was more likely to experience menses during the intervention than the Oligo/Amen Control group (P = 0.002; hazard ratio [CI] = 1.91 [1.27, 2.89]). In the intent-to-treat analysis, the Oligo/Amen + Cal group demonstrated a greater increase in energy intake, body weight, percent body fat and total triiodothyronine (TT3) compared to the Oligo/Amen Control group (P < 0.05). In a subgroup analysis where n = 22 participants were excluded (ambiguous baseline menstrual cycle, insufficient time in intervention for menstrual recovery classification), 64% of the Oligo/Amen + Cal group exhibited improved menstrual function compared with 19% in the Oligo/Amen Control group (χ2, P = 0.001).
LIMITATIONS, REASONS FOR CAUTION
While we had a greater than expected dropout rate for the 12-month intervention, it was comparable to other shorter interventions of 3-6 months in duration. Menstrual recovery defined herein does not account for quality of recovery.
WIDER IMPLICATIONS OF THE FINDINGS
Expanding upon findings in shorter, non-randomised studies, a modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. Improved metabolism, as demonstrated by a modest increase in body weight (4.9%), percent body fat (13%) and TT3 (16%), was associated with menstrual recovery.
STUDY FUNDING/COMPETING INTEREST(S)
This research was supported by the U.S. Department of Defense: U.S. Army Medical Research and Material Command (Grant PR054531). Additional research assistance provided by the Penn State Clinical Research Center was supported by the National Center for Advancing Translation Sciences, National Institutes of Health, through Grant UL1 TR002014. M.P.O. was supported in part by the Loretta Anne Rogers Chair in Eating Disorders at University of Toronto and University Health Network. All authors report no conflict of interest.
TRIAL REGISTRATION NUMBER
NCT00392873.
TRIAL REGISTRATION DATE
October 2006.
DATE OF FIRST PATIENT’S ENROLMENT
September 2006.
Topics: Adult; Energy Intake; Exercise; Female; Humans; Menstruation; Menstruation Disturbances; Oligomenorrhea; United States; Young Adult
PubMed: 34164675
DOI: 10.1093/humrep/deab149 -
Endocrine Connections Jul 2018Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Besides hyperandrogenism, oligomenorrhea and fertility issues, it is associated with... (Review)
Review
Polycystic ovary syndrome (PCOS) is a common disorder in women of reproductive age. Besides hyperandrogenism, oligomenorrhea and fertility issues, it is associated with a high prevalence of metabolic disorders and cardiovascular risk factors. Several genetic polymorphisms have been identified for possible associations with cardiometabolic derangements in PCOS. Different PCOS phenotypes differ significantly in their cardiometabolic risk, which worsens with severity of androgen excess. Due to methodological difficulties, longer time-scale data about cardiovascular morbidity and mortality in PCOS and about possible beneficial effects of different treatment interventions is missing leaving many issues regarding cardiovascular risk unresolved.
PubMed: 29844207
DOI: 10.1530/EC-18-0129 -
American Family Physician Mar 2014Three intrauterine devices (IUDs) are available in the United States: the copper T 380A and two levonorgestrel-releasing IUDs, one that releases 20 mcg of levonorgestrel... (Review)
Review
Three intrauterine devices (IUDs) are available in the United States: the copper T 380A and two levonorgestrel-releasing IUDs, one that releases 20 mcg of levonorgestrel per 24 hours, and one that releases 14 mcg per 24 hours. All are safe and effective methods of contraception that work predominantly by prefertilization mechanisms. The copper T 380A IUD may be placed in nonpregnant women at any time in the menstrual cycle. The prescribing information for the 20- and 14-mcg levonorgestrel-releasing IUDs advises that insertion occur during the first seven days of menses. Insertion immediately after vaginal or cesarean delivery may be considered with the copper T 380A and the 20-mcg levonorgestrel-releasing IUDs; however, expulsion rates are higher than with delayed postpartum insertion. The prescribing information for both levonorgestrel-releasing IUDs advises a waiting period of six weeks postpartum or following second-trimester pregnancy loss. Current guidelines indicate that IUDs are acceptable for use in nulliparous women, in adolescents, and in women who are breastfeeding. They may also be used in women who have a history of sexually transmitted infection, although screening is recommended. IUDs should not be inserted for at least three months after resolution of a sexually transmitted infection. Neither antibiotic prophylaxis nor misoprostol use before IUD insertion is beneficial. If pregnancy occurs, the IUD should be removed if feasible. Possible side effects of levonorgestrel-releasing IUDs include headaches, nausea, hair loss, breast tenderness, depression, decreased libido, ovarian cysts, oligomenorrhea, and amenorrhea. The main side effect of the copper T 380A IUD is increased menstrual bleeding, which may continue even with long-term use.
Topics: Contraception; Equipment Design; Female; Humans; Intrauterine Devices; Pregnancy; Risk Factors; United States
PubMed: 24695563
DOI: No ID Found -
Journal of Infection and Public Health May 2023COVID - 19 vaccine can lead to various local and systemic side effects, including menstrual irregularities in women. There is no robust quantitative evidence of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
COVID - 19 vaccine can lead to various local and systemic side effects, including menstrual irregularities in women. There is no robust quantitative evidence of the association between the COVID - 19 vaccine and menstrual irregularities. A meta-analysis was performed to estimate the pooled prevalence of a range of menstrual disorders that may occur in women following COVID - 19 vaccination.
METHODS
After searching for epidemiological studies, we systematically performed a meta-analysis on PubMed/Medline, EMBASE, and Science Direct. Sixteen studies were finally included in the study. We estimated the pooled prevalence and corresponding 95 % confidence intervals (CIs) for a group of menstrual disorders, including menorrhagia, polymenorrhea, abnormal cycle length, and oligomenorrhea. Heterogeneity was assessed using the I statistic and the Q test.
RESULTS
Overall, the pooled prevalence of menorrhagia was 24.24 % (pooled prevalence 24.24 %; 95 % CI: 12.8-35.6 %). The pooled prevalence of polymenorrhea was 16.2 % (pooled prevalence: 16.2 %; 95 % CI: 10.7-21.6 %). The pooled prevalence of abnormal cycle length was relatively lower than that of the other disorders (pooled prevalence: 6.6 %; 95 % CI: 5.0-8.2 %). The pooled prevalence of oligomenorrhea was 22.7 % (95 % CI: 13.5-32.0 %).
CONCLUSION
The findings indicate that menorrhagia, oligomenorrhea, and polymenorrhea were the most common menstrual irregularities after vaccination. The findings also suggest that a relatively high proportion of women suffer from menstrual irregularities. Further longitudinal studies are needed to confirm the causal relationship between COVID-19 vaccination and menstrual irregularities.
Topics: Female; Humans; COVID-19; COVID-19 Vaccines; Menorrhagia; Menstruation Disturbances; Oligomenorrhea; Vaccination
PubMed: 36934644
DOI: 10.1016/j.jiph.2023.02.019 -
Journal of Traditional Chinese Medicine... Oct 2017Current paper reviews the pharmacological activities, therapeutic indications and phytochemicals of M. longifolia. This herb has been consumed traditionally for the... (Review)
Review
Current paper reviews the pharmacological activities, therapeutic indications and phytochemicals of M. longifolia. This herb has been consumed traditionally for the treatment of various diseases, including gastrointestinal disorders, respiratory disorders, infectious diseases, inflammatory diseases, as well as menstrual disorders. In the modern era, various pharmacological activities have been confirmed for M. longifolia, such as anti-parasitic, antimicrobial, anti-insect, antimutagenic, antinociceptive, anti-inflammatory, antioxidant, keratoprotective, hepatoprotective, anti-diarrhea, and spasmolytic effects. The plant showed therapeutic benefits in irritable bowel syndrome, amenorrhea and oligomenorrhea, and oxidative stress-associated diseases as well. A vast variety of natural components such as flavonoids, phenolic acids, cinnamates, ceramides, sesquiterpenes, terpenes, and terpenoids have been suggested to be responsible for the pharmacological action of M. longifolia. These natural products can be considered as novel medicinal sources for developing new drugs. Further investigations to explore therapeutic efficacy, tolerability, and pharmaceutical properties of M. longifolia phytochemical agents are recommended.
PubMed: 32188234
DOI: No ID Found -
Annals of Palliative Medicine Dec 2021Oligomenorrhea is one of the most frequent gynecologic complaints that interferes with women's life quality. Treatment using traditional Chinese medicine (TCM) is a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oligomenorrhea is one of the most frequent gynecologic complaints that interferes with women's life quality. Treatment using traditional Chinese medicine (TCM) is a preferred alternative therapy for oligomenorrhea. However, systematic reviews (SRs) evaluating the efficacy of TCM treatments for oligomenorrhea remain absent. The present SR and meta-analysis aimed to evaluate the efficacy and safety of TCM treatment for oligomenorrhea.
METHODS
Randomized controlled trials (RCTs) published in English and Chinese were retrieved by searching in the databases in October 2019, including PubMed, Cochrane Library, EMBASE, Sinomed, CNKI, VIP, and WanFang databases. Quantitative analyses and quality assessments were then conducted based on abstracted data. This study protocol is registered PROSPERO, number CRD42018095660.
RESULTS
A total of 26 eligible RCTs involving 2,389 patients were included in our analysis. Overall, we observed an effect of increasing menstrual blood volumes owing to using TCM treatments plus bio-medicine (BM) (n=649; MD, 12.05; 95% CI: 5.23 to 18.87; P<0.00001; I2=96%). Besides, TCM combined with BM yielded a significant prolongation in menstrual periods (MD, 1.20; 95% CI: 0.78 to 1.62; P<0.00001; I2=76%), and had potential improvements on enhancing effectiveness rates, increasing endometrial thickness, and raising the levels of estradiol (E2) and progesterone (P). Concerning adverse events (AEs), no significant difference was found in either group. The quality of evidence was relatively low.
CONCLUSIONS
This study seems to support the potential effect of TCM on treating oligomenorrhea. However, the relatively low quality of prior studies calls for future RCTs to further assess the efficacy of TCM on treating oligomenorrhea using rigorous designs.
Topics: Female; Humans; Medicine, Chinese Traditional; Oligomenorrhea; Quality of Life
PubMed: 33832303
DOI: 10.21037/apm-20-825 -
Hormones (Athens, Greece) 2011To highlight the recent developments in the field of menstrual function in sports and to provide an overview of our current understanding in regard to the... (Review)
Review
OBJECTIVE
To highlight the recent developments in the field of menstrual function in sports and to provide an overview of our current understanding in regard to the pathophysiology, evaluation and management strategies of exercise-related reproductive dysfunction.
DESIGN
A PUBMED search was carried out and all articles published from 1980 to 2010 with title words related to exercise, athletes, menstrual function and primary and secondary amenorrhea were reviewed. The review structure includes a pathophysiology overview, menstrual dysfunction among different athletic disciplines, clinical manifestations, evaluation and management strategies, with particular emphasis on recent data regarding the use of oral contraceptives and hormone replacement therapy.
RESULTS AND CONCLUSION
Exercise-related reproductive dysfunction appears to be multifactorial in origin and remains a diagnosis of exclusion. Recent findings underscore the endocrine role of adipose tissue in the regulation of metabolism and reproduction, providing further data on our understanding of the pathophysiology of exercise-related reproductive dysfunction. Clinical manifestations range from primary amenorrhea or delayed menarche to luteal phase deficiency, oligomenorrhea, anovulation and secondary amenorrhea. Amenorrhea constitutes the most serious clinical consequence and is associated with bone pathology. Early diagnosis, thorough evaluation and individualized management (ranging from diet and exercise, or behavior adjustments to pharmacologic treatment) should be achieved in order to preserve bone mass.
Topics: Amenorrhea; Exercise; Female; Hormone Replacement Therapy; Humans; Infertility, Female; Menstruation; Oligomenorrhea; Reproduction; Sports
PubMed: 21724535
DOI: 10.14310/horm.2002.1300 -
Frontiers in Medicine 2022Anovulation is very common and has several different clinical manifestations, including amenorrhea, oligomenorrhea and abnormal uterine bleeding. Various mechanisms can... (Review)
Review
Anovulation is very common and has several different clinical manifestations, including amenorrhea, oligomenorrhea and abnormal uterine bleeding. Various mechanisms can cause anovulation. The clinical consequences and commonest chronic anovulatory disorder, polycystic ovary syndrome (PCOS), has a prevalence that ranges between 6 to 10% of the global population. While multiple causes can eventually result in PCOS, various methods have been described in the literature for its management, often without ascertaining the underlying cause. Ovulation Induction (OI) is a group of techniques that is used in women with PCOS who are looking to conceive and are unbale to do so with natural means. This narrative review presents a summary of the current evidence and available techniques for OI in women with PCOS, highlighting their performance and applicability.
PubMed: 36035398
DOI: 10.3389/fmed.2022.982230 -
Endocrine Connections May 2018Polycystic ovary syndrome (PCOS) is a heterogenous endocrine disorder with typical symptoms of oligomenorrhoea, hyperandrogenism, hirsutism, obesity, insulin resistance... (Review)
Review
Polycystic ovary syndrome (PCOS) is a heterogenous endocrine disorder with typical symptoms of oligomenorrhoea, hyperandrogenism, hirsutism, obesity, insulin resistance and increased risk of type 2 diabetes mellitus. Extensive evidence indicates that PCOS is a genetic disease and numerous biochemical pathways have been linked with its pathogenesis. A number of genes from these pathways have been investigated, which include those involved with steroid hormone biosynthesis and metabolism, action of gonadotropin and gonadal hormones, folliculogenesis, obesity and energy regulation, insulin secretion and action and many others. In this review, we summarize the historical and recent findings in genetic polymorphisms of PCOS from the relevant publications and outline some genetic polymorphisms that are potentially associated with the risk of PCOS. This information could uncover candidate genes associating with PCOS, which will be valuable for the development of novel diagnostic and treatment platforms for PCOS patients.
PubMed: 29622662
DOI: 10.1530/EC-18-0121 -
Hormone and Metabolic Research =... Aug 2022COVID-19 may influence human fertility and sexuality in several ways. Different cell types in gonads show a constitutive expression of angiotensin-converting enzyme 2... (Review)
Review
COVID-19 may influence human fertility and sexuality in several ways. Different cell types in gonads show a constitutive expression of angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine subtype 2 (TMPRSS2), which provide potential entry pathways for SARS-CoV-2. In addition to the biological effects of a COVID-19 infection on the gonads, the impact of the ongoing COVID-19 pandemic on mental health issues and sexual behavior may affect reproduction. This review summarizes the current knowledge on the influence of COVID-19 on the gonads and discusses possible consequences on human fertility. In this context, the close interaction between the hypothalamic-pituitary-adrenal axis and the hypothalamic-pituitary-gonadal axis in response to COVID-19-related stress is discussed. Some women noticed changes in their menstrual cycle during the COVID-19 pandemic, which could be due to psychological stress, for example. In addition, occasional cases of reduced oocyte quality and ovarian function are described after COVID-19 infection. In men, COVID-19 may cause a short-term decrease in fertility by damaging testicular tissue and/or impairing spermatogenesis. Moreover, decreased ratio testosterone/LH and FSH/LH in COVID-19 compared to aged-matched healthy men has been reported. Available data do not suggest any effect of the available SARS-CoV-2 vaccines on fertility. The effects of long COVID on human fertility have been reported and include cases with premature ovarian failure and oligomenorrhoea in women and erectile dysfunction in men. Despite the increasing knowledge about the effects of COVID-19 infections on human gonads and fertility, the long-term consequences of the COVID-19 pandemic cannot yet be assessed in this context.
Topics: Aged; COVID-19; COVID-19 Vaccines; Female; Fertility; Gonads; Humans; Hypothalamo-Hypophyseal System; Male; Pandemics; Pituitary-Adrenal System; SARS-CoV-2; Post-Acute COVID-19 Syndrome
PubMed: 35853464
DOI: 10.1055/a-1891-6621